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Minimally invasive left ventricular assist device implantation: A comparative study
Prashant N. Mohite, Diana Garcia-Saez, Bartlomiej Zcyh, Anton Sabashnikov, Rachel Hards, Michael Hedger, Kristine Kiff, Gemma Edwards, Olga Ananiadou, Ashok Padukone, Levente Fazekas, Aron Popov, Binu Raj, Christopher Bowles, Fabio DeRobertis, Toufan Bahrami, Mohamed Amrani, Nicholas Banner, Aida Suarez, Andre Simon.
Royal Brompton and Harefield NHS Foundation Trust, Harefield, Uxbridge, United Kingdom.

OBJECTIVE: Left ventricular assist device (LVAD) is now a routine therapy for advanced heart failure. Thoracotomy approach for LVAD implantation is getting popular due to its advantage over conventional sternotomy approach in terms of reduced risk at re-operation due to sternal sparing.
METHODS: Thoracotomy approach involved fitting of LVAD inflow cannula into left ventricle apex via left anterior thoracotomy and anastomosis of outflow graft to ascending aorta via right anterior thoracotomy. In sternotomy approach both the procedures were performed via sternotomy. Outcomes in patients after LVAD implantation were compared depending on the approach for the surgery.
RESULTS: 205 continuous flow LVAD implantations performed between July 2006 and June 2015 at a single center were divided into sternotomy (n=180) and thoracotomy (n=25) groups.
There was no significant difference between the groups in relation to patient demographics, pre-operative hemodynamic parameters, laboratory markers or risk factors. HeartWare and HeartMateII were used in sternotomy approach, while only HeartWare was used in thoracotomy approach. There was no significant difference between the groups in terms of post-op hemodynamic parameters, laboratory markers, bleeding, requirement of blood products, intensive care unit and hospital stay or complications of LVAD surgery. Thoracotomy compared to sternotomy approach, incurred significantly less requirement of temporary right ventricular assist (4 vs 19.4%).
CONCLUSIONS: Minimally invasive thoracotomy approach for LAVD implantation in addition to benefits of sparing sternum, avoids dilatation of right ventricle and reduces chances of right ventricular failure requiring temporary right ventricular assist.

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