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HeartWare Left Ventricular Assist Device Implantation Through Bilateral Anterior Thoracotomy

https://doi.org/10.1016/j.athoracsur.2011.09.055Get rights and content

The HeartWare left ventricular assist device (LVAD) is a new addition to the family of second-generation continuous-flow LVADs. The miniaturized dimensions of the HeartWare LVAD provide the opportunity for its safe implantation through nonsternotomy incisions. We present our technique for HeartWare LVAD implantation through bilateral anterior thoracotomy incisions. This technique has proved to be safe and reproducible, with good clinical outcome.

Section snippets

Technique

Preoperative assessment included a chest computed tomography scan and transthoracic echocardiography. Transesophageal echocardiography was used for intraoperative patient and device assessment. The operation was performed under general anesthesia with a double-lumen endotracheal tube.

A left-sided anterior thoracotomy (8 cm) was performed, and the left pleura was opened through the fifth intercostal space, followed by the opening of the pericardium and exposure of the heart apex. The insertion

Comment

There is a growing trend toward the use of nonsternotomy incisions in all fields of cardiac surgery. Although median sternotomy provides the best access to the heart and the adjacent structures, it could be replaced by smaller thoracotomy incisions in most cases. For patients who will require more than one cardiac operation (for example, VAD implantation as a bridge to transplantation), avoiding median sternotomy in the first operation will reduce the surgical risk of a redo sternotomy in the

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Drs Popov and Hosseini contributed equally to this manuscript.

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