title: Minimal-access left ventricular assist device implantation.
abstract: OBJECTIVE
  The left ventricular assist device (LVAD) is typically implanted through a full sternotomy on cardiopulmonary bypass (CPB). Minimally invasive surgery (MIS) modifications include multiple smaller incisions, using "virgin" territory, and minimized CPB time.
  
  
  METHODS
  Forty-two LVAD implantations were retrospectively reviewed. Twenty-five minimally invasive implantations (MIS, 20 HeartMate II and 5 HeartWare) were compared with 17 sternotomy implantations (12 HeartMate II and 5 HeartWare). The choice of MIS incisions was device dependent: (1) three separate incisions for the HeartMate II or (2) two incisions for the HeartWare device. Four HeartWare LVADs were implanted off-pump (three using the MIS approach).
  
  
  RESULTS
  The median patient age was 52 years (range, 18-69 years). Overall survival was 81% at a mean (SD) follow-up of 495 (375) days. Thirty-day mortality was 9.5% (one MIS and three sternotomy patients). Five patients (11.9%) died while on LVAD, 18 (42.9%) underwent transplantation, 6 (14.3%) underwent weaning and explantation, and 13 (31.0%) remained on support. Preoperative ventilatory and circulatory supports were more common in the sternotomy group. The MIS patients had shorter CPB time [51.4 (34.9) vs 83.6 (40.4) minutes, P = 0.014] and showed a trend toward lower red blood cell and platelet transfusion requirement. The durations of hospitalization, inotropic support, intensive care unit stay, and LVAD support were not significantly different.
  
  
  CONCLUSIONS
  Minimally invasive surgery LVAD implantation is feasible. The shorter CPB duration and off-pump approach may be advantageous. Avoiding sternotomy may also reduce adhesions encountered during subsequent cardiac transplantation.
authors.affiliation: From the Division of *Cardiovascular Surgery, and †Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Jia-Lin
authors.initials: JL
authors.lastname: Soon
authors.forename: Jamil
authors.initials: J
authors.lastname: Bashir
authors.forename: Annemarie
authors.initials: A
authors.lastname: Kaan
authors.forename: Andrew
authors.initials: A
authors.lastname: Ignaszewski
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D055815:Young Adult