Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec;46(6):991-6; discussion 996.
doi: 10.1093/ejcts/ezu051. Epub 2014 Mar 12.

Viennese approach to minimize the invasiveness of ventricular assist device implantation†

Thomas Haberl  1 , Julia Riebandt  1 , Stephane Mahr  1 , Guenther Laufer  1 , Angela Rajek  2 , Heinrich Schima  3 , Daniel Zimpfer  4
Affiliations

Viennese approach to minimize the invasiveness of ventricular assist device implantation†

Thomas Haberl et al. Eur J Cardiothorac Surg. 2014 Dec.

Abstract

Objective: Avoiding full sternotomy and cardiopulmonary bypass (CPB) could significantly reduce the invasiveness of left ventricular assist device (LVAD) implantation. Therefore, we developed minimally invasive implant strategies for the Heartware® VAD (HVAD) and the Thoratec® HeartMate II (HMII) covering isolated LVAD implantation as well as concomitant valve procedures (aortic/tricuspid). We present the surgical techniques and the initial clinical experience.

Methods: From February 2012 to March 2013, 27 patients (mean age 58 ± 8 years; male 85%; Ischemic Cardiomyopathy 63%; redo surgery 22%; Interagency Registry for Mechanically Assisted Circulatory Support Level I: 29%, II: 22%, III: 33%, IV-VII: 16%) underwent minimally invasive LVAD implantation at our department. Apical cannulation was performed via a left lateral minithoracotomy in HVAD patients (n = 20) or a left subcostal incision in HMII patients (n = 7). The outflow graft anastomosis was performed to the ascending aorta via a right minithoracotomy in the second intercostal space (n = 22) or the right subclavian artery (n = 2). If additional valve procedures (aortic/tricuspid) were necessary (n = 3), a hemisternotomy was performed to access the valve and perform the outflow graft anastomosis. Circulatory support for LVAD implantation was CPB (33%), extracorporeal membrane oxygenation (48%) or off-pump (19%).

Results: The minimally invasive approach was feasible in all patients with no need for conversions. Thirty-day and in-hospital mortality were 7.4 and 14.8%, respectively. In-hospital stay was 30.0 ± 22.5 days. One patient (4%) died during follow-up from pump thrombus formation. Three patients (11%) underwent surgical revision for bleeding.

Conclusions: Minimally invasive LVAD implantation is feasible and safe. The very encouraging results obtained in this initial series justify a broad application of this technique.

Keywords: Minimal invasive implantation; Ventricular assist device.

PubMed Disclaimer

LinkOut - more resources