Minimally Invasive Ventricular Assist Device Surgery

Abstract

The use of mechanical circulatory support to treat patients with congestive heart failure has grown enormously, recently surpassing the number of annual heart transplants worldwide. The current generation of left ventricular assist devices (LVADs), as compared with older devices, is characterized by improved technologies and reduced size. The result is that minimally invasive surgery is now possible for the implantation, explantation, and exchange of LVADs. Minimally invasive procedures improve surgical outcome; for example, they lower the rates of operative complications (such as bleeding or wound infection). The miniaturization of LVADs will continue, so that minimally invasive techniques will be used for most implantations in the future. In this article, we summarize and describe minimally invasive state-of-the-art implantation techniques, with a focus on the most common LVAD systems in adults.

Minimally Invasive Implantation of HeartWare Assist Device and Simultaneous Tricuspid Valve Reconstruction Through Partial Upper Sternotomy

“…Additionally, in 2015 Wagner et al demonstrated the feasibility of minimally invasive VAD implantation without the use of extracorporeal circulation . However, the optimal operative strategy is still under discussion .…”

Aortic Outflow Graft Stenting in Patient With Left Ventricular Assist Device Outflow Graft Thrombosis

“…After being the first center to implant LVADs using a minimally invasive procedure (1,3), the Hannover group was also the first to describe a simple technique for minimally invasive LVAD exchanges (8) as well as explantations (7). Yet, this technique would not have been applicable to our…”

“…As left ventricular assist device (LVAD) implantations are increasing worldwide (1)(2)(3)(4), VAD complications such as pump and outflow graft thrombosis become more and more clinically important and therefore a focus of current research projects (5,6). LVAD thrombosis formation is a complex topic, which is comprised of anticoagulation strategies, pump mechanics, and surgical techniques.…”

Minimally invasive thoracoscopically-guided right minithoracotomy versus conventional sternotomy for mitral valve repair

“…They are often popular with patients, promoted by industry, and are being adopted by surgeons (73)(74)(75). In cardiac surgery, minimally invasive approaches are also used for coronary revascularisation (76) aortic valve surgery (77) aortic root surgery (78), and surgery for assist devices (79).…”