title: Viennese approach to minimize the invasiveness of ventricular assist device implantation†.
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.
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Haberl
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Riebandt
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Stephane
authors.initials: S
authors.lastname: Mahr
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.affiliation: Department of Anesthesiology and Pain Care, Medical University of Vienna, Vienna, Austria.
authors.forename: Angela
authors.initials: A
authors.lastname: Rajek
authors.affiliation: Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schima
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria daniel.zimpfer@meduniwien.ac.at.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
mesh_terms: D000368:Aged; D001317:Austria; D009202:Cardiomyopathies / Q000601:surgery; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D017202:Myocardial Ischemia / Q000601:surgery; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
keywords: Minimal invasive implantation; Ventricular assist device