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Ventricular assist device implantation using a right thoracotomy.
ASAIO J. 2006 Jul-Aug; 52(4):386-90.AJ

Abstract

Most patients needing implantation of a ventricular assist device (VAD) require repeated sternotomy; some after cardiac surgery, and others later for heart transplantation. The purpose of this study was to establish the right thoracotomy technique as an alternative for VAD implantation to reduce repeated sternotomy-related morbidity and mortality. We performed a right thoracotomy in animals, preclinical cadaver fitting tests, and a clinical case. A total of 20 various animals underwent right thoracotomy for implantation of bi-VAD (BVAD, n = 17) and left VAD (LVAD, n = 3). The right chest cavity was entered through the fourth intercostal space with partial resection of the fifth rib. There was no procedure-related morbidity or mortality, except for one calf with right anterior leg paralysis. Preclinical fitting tests were performed on 7 human cadavers to observe the anatomical feasibility of BVAD cannulation from the right side of the heart. In humans, the ascending aorta, interatrial groove, right atrium, and main pulmonary artery were identified as optimal cannula insertion sites for BVAD implantation. A patient with cardiogenic shock underwent a right thoracotomy for implantation of an external LVAD. Cardiac function recovered after 3 weeks, and the device was successfully explanted through a repeat right thoracotomy. In conclusion, a right thoracotomy can be an alternative method to the standard median sternotomy for patients who need repeated sternotomy because of previous cardiac surgery, transplantation at a later date, or those with mediastinal infections.

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Authors+Show Affiliations

Son HS
Department of Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea.
Sun K
No affiliation info available
Hwang CM
No affiliation info available
Fang YH
No affiliation info available
Lim CH
No affiliation info available
Lee HW
No affiliation info available
Park SM
No affiliation info available
Shin JS
No affiliation info available
Kim KT
No affiliation info available
Kim HM
No affiliation info available

MeSH

AgedAnimalsAortaCattleDogsFemaleHeart AtriaHeart-Assist DevicesHumansMaleMiddle AgedProsthesis DesignProsthesis FittingProsthesis ImplantationPulmonary ArterySheepThoracotomy

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16883117

Citation

Son, Ho Sung, et al. "Ventricular Assist Device Implantation Using a Right Thoracotomy." ASAIO Journal (American Society for Artificial Internal Organs : 1992), vol. 52, no. 4, 2006, pp. 386-90.
Son HS, Sun K, Hwang CM, et al. Ventricular assist device implantation using a right thoracotomy. ASAIO J. 2006;52(4):386-90.
Son, H. S., Sun, K., Hwang, C. M., Fang, Y. H., Lim, C. H., Lee, H. W., Park, S. M., Shin, J. S., Kim, K. T., & Kim, H. M. (2006). Ventricular assist device implantation using a right thoracotomy. ASAIO Journal (American Society for Artificial Internal Organs : 1992), 52(4), 386-90.
Son HS, et al. Ventricular Assist Device Implantation Using a Right Thoracotomy. ASAIO J. 2006 Jul-Aug;52(4):386-90. PubMed PMID: 16883117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ventricular assist device implantation using a right thoracotomy. AU - Son,Ho Sung, AU - Sun,Kyung, AU - Hwang,Chang Mo, AU - Fang,Yong Hu, AU - Lim,Choon Hak, AU - Lee,Hye Won, AU - Park,Sung Min, AU - Shin,Jae Seung, AU - Kim,Kwang Taik, AU - Kim,Hyoung Mook, PY - 2006/8/3/pubmed PY - 2006/9/30/medline PY - 2006/8/3/entrez SP - 386 EP - 90 JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) JO - ASAIO J VL - 52 IS - 4 N2 - Most patients needing implantation of a ventricular assist device (VAD) require repeated sternotomy; some after cardiac surgery, and others later for heart transplantation. The purpose of this study was to establish the right thoracotomy technique as an alternative for VAD implantation to reduce repeated sternotomy-related morbidity and mortality. We performed a right thoracotomy in animals, preclinical cadaver fitting tests, and a clinical case. A total of 20 various animals underwent right thoracotomy for implantation of bi-VAD (BVAD, n = 17) and left VAD (LVAD, n = 3). The right chest cavity was entered through the fourth intercostal space with partial resection of the fifth rib. There was no procedure-related morbidity or mortality, except for one calf with right anterior leg paralysis. Preclinical fitting tests were performed on 7 human cadavers to observe the anatomical feasibility of BVAD cannulation from the right side of the heart. In humans, the ascending aorta, interatrial groove, right atrium, and main pulmonary artery were identified as optimal cannula insertion sites for BVAD implantation. A patient with cardiogenic shock underwent a right thoracotomy for implantation of an external LVAD. Cardiac function recovered after 3 weeks, and the device was successfully explanted through a repeat right thoracotomy. In conclusion, a right thoracotomy can be an alternative method to the standard median sternotomy for patients who need repeated sternotomy because of previous cardiac surgery, transplantation at a later date, or those with mediastinal infections. SN - 1058-2916 UR - https://www.unboundmedicine.com/medline/citation/16883117/Ventricular_assist_device_implantation_using_a_right_thoracotomy_ L2 - https://doi.org/10.1097/01.mat.0000227692.75032.86 DB - PRIME DP - Unbound Medicine ER -