Minimally invasive implantation of left ventricular assist device HeartWare HVAD

IntroductionLong-term left ventricular assist devices are nowadays part of standard therapy for patients in terminal phase of heart failure. Lower invasiveness of implantation might have the potential to enhance results of these high risk patients. The aim of this study is to introduce our minimally invasive approach to the implantation of left ventricular assist device of the latest generation HeartWare ventricle assist device (HVAD) and our initial experience with this method.MethodsIn our department we implanted HVAD between November 2013 and November 2014 in 8 patients as a bridge to heart transplantation. All patients were male with average age 59.5 ± 6.4 years. Basic diseases were dilated cardiomyopathy in 6 patients (75%), ischemic cardiomyopathy in 2 patients (25%). The mean value of left ventricular ejection fraction was 10 ± 3.6%, right ventricular ejection fraction was 35 ± 5.6%. Access to the left ventricular apex was reached by left-sided thoracotomy of approximately 8 cm. To access the ascending aorta we used upper J ministernotomy.ResultsMinimally invasive implantation was successfully done in all patients. In one patient closure of foramen ovale was simultaneously performed. Most patients (75%) were extubated on the first postoperative day. In one case, a failure of the right ventricle occurred with the need for temporary right-sided circulatory support device Centrimag. No patient died, four patients have successfully undergone heart transplantation, other are followed on an outpatient basis.ConclusionMinimally invasive implantation of left ventricular assist device HeartWare HVAD is safely feasible. After a very good initial experience with this technique it has become the method of choice in our department.