Viennese approach to minimize the invasiveness of ventricular assist device implantation

Abstract

Minimally invasive LVAD implantation is feasible and safe. The very encouraging results obtained in this initial series justify a broad application of this technique.

Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients

“…17 Early postoperative anticoagulation therapy was initiated with low-molecular-weight heparin and changed to phenprocoumon thereafter. 18 Antithrombotic therapy was added with acetylsalicylic acid (200 mg/d) in accordance with the institutional protocol.…”

Robotic-Assisted Implantation of Ventricular Assist Device After Sternectomy and Pectoralis Muscle Flap

“…The existing minimally invasive approaches which involve anastomosis to the aorta include either implantation via a J ministernotomy with extension into the right third intercostal space and minithoracotomy through the left fifth intercostal space or via the Viennese method, which includes minithoracotomies through the left fourth or fifth intercostal space and right second intercostal space. [5,6] Anastomosis of the outflow graft to peripheral sources such as the left subclavian artery was not desirable due to the non-physiologic blood pressure and bidirectional flow which occurs in the subclavian as a result. [7] Our approach improves on previously described non-robotic thoracotomy approaches as it provides optimal visualization for RV dissection with reduced risk of kinking of the outflow graft while still allowing anastomosis to the aorta.…”

Minimally Invasive Right Ventricular Assist Device Implantation in a Patient with HeartWare left ventricular Assist Device

“…Recently, many centers reported positive outcome when the LVAD is implanted using a minimally invasive approach. 1,2 The main drawback of these minimally invasive approach is the feasibility of RVAD implantation with direct cannulation of the pulmonary artery in cases of RVF. Therefore, many surgeons tend to use temporary peripheral venoarterial extracorporeal life support in this setting.…”