title: Median Sternotomy or Right Thoracotomy Techniques for Total Artificial Heart Implantation in Calves.
abstract: The choice of optimal operative access technique for mechanical circulatory support device implantation ensures successful postoperative outcomes. In this study, we retrospectively evaluated the median sternotomy and lateral thoracotomy incisions for placement of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) in a bovine model. The CFTAH was implanted in 17 calves (Jersey calves; weight range, 77.0-93.9 kg) through a median sternotomy (n = 9) or right thoracotomy (n = 8) for elective chronic implantation periods of 14, 30, or 90 days. Similar preoperative preparation, surgical techniques, and postoperative care were employed. Implantation of the CFTAH was successfully performed in all cases. Both methods provided excellent surgical field visualization. After device connection, however, the median sternotomy approach provided better visualization of the anastomoses and surgical lines for hemostasis confirmation and repair due to easier device displacement, which is severely limited following right thoracotomy. All four animals sacrificed after completion of the planned durations (up to 90 days) were operated through full median sternotomy. Our data demonstrate that both approaches provide excellent initial field visualization. Full median sternotomy provides larger viewing angles at the anastomotic suture line after device connection to inflow and outflow ports.
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA. karimoj@ccf.org.
authors.forename: Jamshid H
authors.initials: JH
authors.lastname: Karimov
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.|Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cardiac Transplantation, and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland, OH, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Gengo
authors.initials: G
authors.lastname: Sunagawa
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Byram
authors.affiliation: Anesthesiology Institute, Cleveland, OH, USA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Sale
authors.affiliation: Biological Resources Unit, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Such
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Horvath
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Leonard A R
authors.initials: LA
authors.lastname: Golding
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
mesh_terms: D000818:Animals; D002417:Cattle; D005260:Female; D006354:Heart, Artificial; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*
keywords: Device implantation; Median sternotomy; Right thoracotomy; Surgical access; Total artificial heart