How to do itOff-Pump Implantation of the HeartWare HVAD Left Ventricular Assist Device Through Minimally Invasive Incisions
Section snippets
Patient
Recurrent episodes of decompensated heart failure requiring inotropic support developed in a 48-year-old woman with ischemic cardiomyopathy. Her echocardiogram showed an ejection fraction of 0.15, with dilatation of the left ventricle (end-diastolic dimension, 64 mm). The patient did not tolerate weaning of the inotropes, which led to the decision to implant a long-term LVAD. The patient was scheduled to receive a HVAD device under Canadian special access protocol.
Device
The HVAD is a small
Comment
The patient in this report received the HVAD through minimal incisions, without the use of CPB. The implantation of this device without the use of CPB was reported in only 2% of the cases of the early European and Australian experience [4], and a full sternotomy was used in 86%. Other authors have inserted the HeartMate II (Thoratec, Pleasanton, CA) or the Jarvik 2000 (Jarvik Heart, New York, NY) through a combination of subcostal incision and ministernotomy, with or without the use of CPB [1].
References (4)
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A less invasive approach to axial flow pump insertion
J Heart Lung Transplant
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Off-pump implant of the Jarvik 2000 ventricular assist device through median sternotomy
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Cited by (68)
Left ventricular assist device implantation via lateral thoracotomy: A systematic review and meta-analysis
2022, Journal of Heart and Lung TransplantationExpert Consensus Paper: Lateral Thoracotomy for Centrifugal Ventricular Assist Device Implant
2021, Annals of Thoracic SurgeryAmerican Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support
2020, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Nonsternotomy approaches include subcostal and left thoracotomy approaches to the LV apex and upper partial sternotomy or a right thoracotomy to perform outflow graft anastomosis. Although most operators have used these approaches to perform standard implantation, others have developed implantation without cardiopulmonary bypass, alternative outflow graft location (axillary/subclavian artery and descending thoracic aorta), as well as robotic implantation.101,102 Such nonsternotomy approaches have been reported to achieve lower transfusion rates and shorter length of postsurgical stay as well as offer potential benefits at reoperation for cardiac transplantation.102,103
American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support
2020, Journal of Heart and Lung TransplantationCitation Excerpt :Nonsternotomy approaches include subcostal and left thoracotomy approaches to the LV apex and upper partial sternotomy or a right thoracotomy to perform outflow graft anastomosis. Although most operators have used these approaches to perform standard implantation, others have developed implantation without cardiopulmonary bypass, alternative outflow graft location (axillary/subclavian artery and descending thoracic aorta), as well as robotic implantation.101,102 Such nonsternotomy approaches have been reported to achieve lower transfusion rates and shorter length of postsurgical stay as well as offer potential benefits at reoperation for cardiac transplantation.102,103
I Am the Clinical Trial
2019, JACC: Heart FailureEvaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: The LATERAL clinical trial
2019, Journal of Heart and Lung Transplantation