Less Invasive Techniques for Left Ventricular Assist Device Implantation

The decreasing size in continuous flow left ventricular assist devices has facilitated alternative approaches to implantation with nonsternotomy approaches increasing in adaptation over the last 5 years. Preserving the sternum for easier reoperation at cardiac transplant, decreasing the necessary dissection, and preservation of right ventricular function are potential benefits of such techniques. Most operative approaches use a left thoracotomy to access the left ventricular apex for inflow placement and variably combine an upper sternotomy or right thoracotomy with standard aortic graft placement. In patients with alternative outflow sites, most of the operation is performed through a left thoracotomy incision. With these approaches, the need for cardiopulmonary bypass is assessed with many operators avoiding its use for left ventricular assist device implantation. Additional potential benefits included decreased transfusion and shorter operative times, which may facilitate earlier hospital discharge.