title: A less invasive approach to axial flow pump insertion.
abstract: BACKGROUND
  Implantation of a HeartMate II or a Jarvik 2000 FlowMaker left ventricular assist system (LVAS) usually involves a mid-line sternotomy and the use of cardiopulmonary bypass (CPB). In patients with numerous co-morbid conditions, however, surgical trauma may be minimized by implanting the LVAS via a minimally invasive approach, preferably without CPB.
  
  
  METHODS
  In 6 patients with end-stage heart failure and other serious co-morbidities, we implanted a HeartMate II (n = 3) or a Jarvik 2000 FlowMaker (n = 3) LVAS via a right mini-thoracotomy and a left sub-costal incision. Patients included 3 men and 3 women with a mean age of 41 years. In 3 cases, the LVAS was implanted without CPB.
  
  
  RESULTS
  After a mean follow-up period of 6 months, 5 patients are alive and well and on the transplant waiting list. Seven months after LVAS implantation, the remaining patient developed a hemorrhagic stroke necessitating Jarvik 2000 replacement with a new pump of the same type.
  
  
  CONCLUSIONS
  In this small series, the combined sub-costal and mini-thoracotomy incision proved safe and technically feasible. It may be useful for other LVAS candidates who have serious co-morbidities that preclude traditional implant operations.
authors: Department of Heart Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA. igregoric@heart.thi.tmc.edu
authors: Igor D
authors: ID
authors: Gregoric
authors: Saverio
authors: S
authors: La Francesca
authors: Tim
authors: T
authors: Myers
authors: William
authors: W
authors: Cohn
authors: Pranav
authors: P
authors: Loyalka
authors: Biswajit
authors: B
authors: Kar
authors: Courtney
authors: C
authors: Gemmato
authors: O H
authors: OH
authors: Frazier
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D002543:Cerebral Hemorrhage / Q000150:complications; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011182:Postoperative Care; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D020521:Stroke / Q000209:etiology / Q000601:surgery; D013908:Thoracotomy