Durable Left Ventricular Assist Device Implant Procedures and Techniques

The evolution of centrifugal-flow pumps towards more compact design and easier handling has led to various left ventricular assist device (LVAD) implantation techniques. The median sternotomy remains the predominant surgical approach, offering comprehensive exposure and the flexibility to perform concomitant procedures. However, less invasive techniques, such as left lateral thoracotomy combined with hemi-sternotomy or right anterior thoracotomy, are gaining popularity due to their reduced invasiveness For less invasive approaches, preoperative computed tomography is indispensable. As is standard in cardiac surgery, general anesthesia and orotracheal intubation are required for LVAD implantation.Use of cardiopulmonary bypass (CPB) has become a subject of debate. While CPB has traditionally been used for its ability to facilitate stable hemodynamics and left ventricular inspection which potentially lowers the risk of postoperative stroke, studies have highlighted an associated increase in blood product transfusion requirement compared to off-pump implantation techniques.