Thorac Cardiovasc Surg 2013; 61 - OP53
DOI: 10.1055/s-0032-1332292

Minimal invasive LVAD implantation via bilateral thoracotomy

T Haberl 1, S Mahr 1, J Riebandt 1, G Laufer 1, A Rajek 2, H Schima 3, D Zimpfer 1
  • 1Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
  • 2Medical University of Vienna, Department of Anesthesiology, Vienna, Austria
  • 3Medical University of Vienna, Department of Biomedical Engineering, Vienna, Austria

Objective: A median sternotomy is the standard incision for left ventricular assist device (LVAD) implantation. There are some theoretical advantages of avoiding a median sternotomy in LVAD patients including better right ventricular protection, improved pulmonary function and faster recovery. The present study was designed to evaluate a novel, minimally invasive sternotomy sparing technique for LVAD implantation.

Methods: From February 2012 to September 2012 10 patients (mean age 55.5 ± 11.1yrs., 90% male, ischemic heart disease 70%, prior cardiac surgery 10%) with terminal heart failure (Intermacs level 1: 30%, level 2 10%, level 3 40%, level 4 – 7 20%) underwent minimally invasive isolated sternotomy sparing LVAD implantation (Heartware® HVAD n = 9, Thoratect® HMII n = 1). Surgical access was established by a left minithoracotomy directly over the apex, the outflow graft was tunneled to the aorta intrapericardially in all but redo cases. The aortic outflow anastomosis was performed via a right minithoracotomy in the 2nd intercostal space. Circulatory support for LVAD implantation was performed using CPB or ECMO.

Results: Sternotomy sparing LVAD implantation was feasible in all patients with no need for conversions. Thirty-day and in-hospital mortality was 0%. Median time on respirator was 2.2 ± 3.4 days, overall in-hospital stay was 32.6 ± 8.5 days. One patient (10%) died during follow-up from pump thrombus formation. One patient underwent surgical revision for postoperative bleeding (retroperitoneal haematoma). We observed no permanent neurological deficits and relevant infections.

Conclusion: Minimally invasive sternotomy sparing left ventricular assist device implantation is feasible and safe. The very encouraging results obtained in this initial series justify a broad application of this technique.