Thoracotomy-based Left Ventricular Assist Device implantation

S. Yoshida, B. Bryner, D. Pham
Northwestern University Feinberg School of Medicine, Chicago, Illinois

Please explain the educational or technical point that this video addresses.: less invasive LVAD implantation reserving partial pericardium and sternum.

Please provide a 250 word summary of the surgical video being submitted.: Durable mechanical circulatory support systems, such as left ventricular assist devices (LVADs), have become an established therapy option for patients with end-stage heart failure. With the increasing importance of mechanical circulatory support due to donor organ shortage, there has been a focus on developing less invasive surgical approaches for LVAD implantation. This abstract presents the viability and advantages of a less invasive approach compared to the traditional median sternotomy approach. Numerous reports and studies have demonstrated the potential benefits of minimizing surgical trauma and reducing cardio-pulmonary bypass-related complications. The less invasive implant strategies for LVADs aim to minimize or avoid sternal trauma, prevent heart luxation, and preserve a major part of the pericardium. These approaches have been shown to result in fewer blood transfusions, reduced hemodialysis requirements, shorter intensive care unit and hospital stays, and lower rates of right ventricular failure, without an increased risk of adverse events. Our group has adopted a minimally invasive surgical technique utilizing upper hemi-sternotomy and left antero-lateral thoracotomy approaches in anatomically suitable patients. This video provides an example of our experience in implementing this less invasive approach for LVAD implantation.