No Visible Scars LVAD Implantation

Objectives: The treatment of heart failure is an expanding field in cardiac surgery. Recently, the “Lateral-Trial” demonstrated superiority of MICS-LVAD by means of reduced right heart failure. To sew the outflow graft to the aorta, partial sternotomy and anterolateral thoracotomy through second intercostal space are established. Both have limitations; sternal instability, rib luxation, and lung herniation are rare but do exist. Herein we propose a new access for the outflow-graft anastomosis leaving the osseous thorax untouched.

Methods: Two access sites are generated: (1) left anterolateral thoracotomy as usual to access the apex and (2) a 5-cm skin incision in the right axilla is made to open the third intercostal space in the right anterior axillary line. The procedure is presented in a detailed video.

Results: We present an exemplary case with a 61-year-old female undergoing elective MICS-HVAD implantation, with higher risk for impaired wound healing due to overweight (160 cm, 95 kg) and diabetes. The procedure itself was uncomplicated. The postoperative result showed superior cosmetics as well as uncomplicated wound healing.

Conclusion: The presented technique allowed excellent access to the ascending aorta without being a circus act. Additionally, despite being subordinate, the cosmetic result is superior without any visible scars from front view.