title: Minimally invasive surgical Jarvik 2000 off-pump implantation.
abstract: Therapy with mechanical ventricular assist devices (VADs) in severe heart failure, open to discussion decades ago, is now well established for temporary or long-term support. The typical VAD candidate is very compromised and may not have sufficient resources to tolerate major surgical insults and trauma. Therefore, device implantation through smaller, less traumatic incisions is a desirable goal. The median sternotomy decreases lung volumes and reduces thoracic motion with a significant decrease in functional residual capacity and total lung capacity months later. Minimally invasive cardiac surgery was devised to reduce morbidity because of its potentially less inflammatory response, reduced transfusion requirements and minimal scarring with consequent rapid rehabilitation to normal life activity. Additionally, avoiding cardiopulmonary circulatory support (CPB) even for a short period might reduce the release of inflammatory cytokines and their consequences, as most CPB-related damage happens within the first few minutes. We describe the tricks and traps of minimally invasive approach during VAD implantation, by associating mini-anterior left thoracotomy in the fifth intercostal space with a mini-anterior right thoracotomy in the second intercostal space, without the aid of CPB in paravertebral block regional analgesia combined with mild general anasthesia.
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy jonidabg@gmail.com.
authors: Jonida
authors: J
authors: Bejko
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Alvise
authors: A
authors: Guariento
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Giacomo
authors: G
authors: Bortolussi
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Vincenzo
authors: V
authors: Tarzia
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Gino
authors: G
authors: Gerosa
authors: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Tomaso
authors: T
authors: Bottio
mesh_terms: D002315:Cardiopulmonary Bypass; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D056346:Sternotomy; D013908:Thoracotomy / Q000379:methods*
keywords: Left ventricular assist device; Minimally invasive procedure; Paravertebral block analgesia