A less invasive approach to axial flow pump insertion

J Heart Lung Transplant. 2008 Apr;27(4):423-6. doi: 10.1016/j.healun.2008.01.002.


Background: Implantation of a HeartMate II or a Jarvik 2000 FlowMaker left ventricular assist system (LVAS) usually involves a mid-line sternotomy and the use of cardiopulmonary bypass (CPB). In patients with numerous co-morbid conditions, however, surgical trauma may be minimized by implanting the LVAS via a minimally invasive approach, preferably without CPB.

Methods: In 6 patients with end-stage heart failure and other serious co-morbidities, we implanted a HeartMate II (n = 3) or a Jarvik 2000 FlowMaker (n = 3) LVAS via a right mini-thoracotomy and a left sub-costal incision. Patients included 3 men and 3 women with a mean age of 41 years. In 3 cases, the LVAS was implanted without CPB.

Results: After a mean follow-up period of 6 months, 5 patients are alive and well and on the transplant waiting list. Seven months after LVAS implantation, the remaining patient developed a hemorrhagic stroke necessitating Jarvik 2000 replacement with a new pump of the same type.

Conclusions: In this small series, the combined sub-costal and mini-thoracotomy incision proved safe and technically feasible. It may be useful for other LVAS candidates who have serious co-morbidities that preclude traditional implant operations.

MeSH terms

  • Adult
  • Blood Transfusion
  • Cerebral Hemorrhage / complications
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Heart Failure / complications
  • Heart Failure / surgery*
  • Heart-Assist Devices*
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures* / methods
  • Postoperative Care
  • Postoperative Complications / surgery
  • Reoperation
  • Stroke / etiology
  • Stroke / surgery
  • Thoracotomy