Technique for less invasive implantation of heartmate II left ventricular assist device without median sternotomy

The standard implantation of the Heartmate II left ventricular assist device (LVAD) (Thoratec Inc, Pleasanton, CA) involves a median sternotomy. There are some theoretical advantages to avoiding a median sternotomy in LVAD implantation. Hill et al. ¹ introduced the concept of implantation of LVADs via a combination of right mini-thoracotomy and left subcostal incision and used this approach to implant the Thoratec paracorporeal LVAD (Thoratec Inc). Gregoric et al. ² subsequently described a less invasive approach for implanting the Heartmate II LVAD without median sternotomy by using a subcostal incision and a right mini-thoracotomy, and they used the approach in 3 patients. With some modifications, we now use this method for routine implantation of the Heartmate II and describe our technique.