A less invasive approach to axial flow pump insertion.
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.
Gregoric
Igor D
ID
Department of Heart Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA. igregoric@heart.thi.tmc.edu
La Francesca
Saverio
S
Myers
Tim
T
Cohn
William
W
Loyalka
Pranav
P
Kar
Biswajit
B
Gemmato
Courtney
C
Frazier
O H
OH
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