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A safe, alternative technique for off-pump left ventricular assist device implantation in high-risk reoperative cases

Department of Adult Cardiac Surgery, ‘La Timone’ University Hospital, Marseille, France

^* Corresponding author. Address: Service de chirurgie Cardiaque Adulte, Hopital La Timone, 264 Rue St Pierre, 13005 Marseille, France. Tel.: +33-04-91-38-57-17; fax: +33-491-38-49-26
fcollart{at}univ-aix.fr

The implant of a ventricular assist device is a standardized procedure. However, it carries a high-risk in reoperations, especially if there are patent by-pass grafts. An isolated thoracotomy has been previously described as an alternative access route in these patients, but it offers a limited exposure should intraoperative right-heart failure occur. In the following, we describe an alternative, off-pump technique that combines a median sternotomy with limited dissection of the right-heart with a left anterolateral thoracotomy. In our experience, it proves to be a safe way for the LVAD insertion in these high-risk patients.

Key Words: Left ventricular assist device; Reoperation; Off-pump