title: Minimally invasive and alternative approaches for long-term LVAD placement: the Vanderbilt strategy.
abstract: BACKGROUND
  Minimally invasive and alternative strategies for implantation have been anecdotally reported for contemporary continuous-flow left ventricular assist device (CF-LVAD) placement.
  
  
  METHODS
  We reviewed our experience at a single center with alternative strategies for implantation of the HeartMate II and HeartWare CF-LVADs, in patients with advanced heart failure (HF). This featured article focuses on the associated surgical techniques and patient management pitfalls.
  
  
  RESULTS
  For appropriately selected cases, our group believes that these alternative strategies allow for the development of novel and less traumatic surgical approaches for CF-LVAD implantation. With reproducible outcomes, these approaches also promise the possibility of increasing the number of high-risk surgical patients who could benefit from CF-LVAD therapies.
  
  
  CONCLUSIONS
  This work has detailed a variety of less invasive alternative strategies for implantation of long-term LVADs. These newer approaches have the potential for significant advancements in the field of cardiothoracic surgery. Large-scale collaborative studies will be needed to clarify the potential advantages and disadvantages of these novel techniques on patient outcomes.
authors.affiliation: 1 Department of Cardiothoracic Surgery, 2 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232-8808, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.affiliation: 1 Department of Cardiothoracic Surgery, 2 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232-8808, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.affiliation: 1 Department of Cardiothoracic Surgery, 2 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232-8808, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Haglund
keywords: Left thoracotomy; left ventricular assist device (LVADs); minimally invasive