Minimally invasive and robotic techniques for implantation of ventricular assist devices in patients with heart failure.

Abstract

Introduction: Minimally invasive approaches to cardiac surgery have been developing over the last several decades, including less invasive strategies to implantation of durable left ventricular assist devices (LVAD). Less invasive approaches to LVAD insertion aim to reduce surgical trauma and promote shorter hospital stay and recovery times; and for those bridged to heart transplantation, they aim to facilitate later reentry.

Areas covered: PubMed was searched from 1980 to present to identify existing literature regarding non-sternotomy approaches to LVAD insertion. This review outlines the history and early attempts of sternal sparing LVAD insertion, commonly utilized surgical approaches in contemporary practice, as well as the experience with concomitant procedures using these approaches. Additionally, a summary of postoperative outcomes described in the literature is provided. Lastly, this review describes the early use of robotic assistance in durable LVAD implantation.

Expert opinion: Sternal sparing approaches to LVAD insertion are feasible, safe, and in multiple experiences, have been shown to reduce operative and postoperative blood loss, reoperation, right ventricular dysfunction, and hospital length of stay. The use of surgical robotics in LVAD implantation remains at its infancy but poses a promising avenue to a totally endoscopic approach to durable mechanical assist therapy.