Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Expert Rev Med Devices. 2020 Apr;17(4):323-330. doi: 10.1080/17434440.2020.1735358. Epub 2020 Mar 2.
: The global heart failure (HF) burden is expected to increase due to aging populations, increasing number of end-stage HF patients and adverse lifestyle changes. Mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs) have become a promising treatment option for short-term and long-term circulatory support of end-stage HF patients.: Recent developments in MCS technology have been focused on miniaturization leading to the development of minimally invasive surgical procedures for LVAD implantation. This helps overcome possible postoperative complications such as major incisions and poor outcomes due to infections, right heart failure, and bleeding. This article discusses clinical and technological developments in the field of minimally invasive procedures for LVAD implantation.: Most patients might benefit from minimally invasive LVAD implantation performed through a limited left lateral thoracotomy associated with an upper hemisternotomy or a right anterior thoracotomy. The thoracotomy approach can also be considered in case of pump exchange or pump explant. The success of these techniques is mainly based on the optimization of LVAD pump design, inflow cannula insertion, and outflow graft as well as driveline exit sites. The future direction of the LVAD field is likely to include less-invasive approaches and smartificial technologies.
全球心力衰竭（HF）负担预计将增加，原因是人口老龄化、终末期 HF 患者数量增加以及生活方式的不利变化。机械循环支持（MCS）设备，如左心室辅助装置（LVAD），已成为终末期 HF 患者短期和长期循环支持的有前途的治疗选择。
MCS 技术的最新进展集中在小型化上，从而开发了 LVAD 植入的微创手术。这有助于克服术后并发症，如大切口和因感染、右心衰竭和出血导致的不良结果。本文讨论了 LVAD 植入微创手术领域的临床和技术进展。
大多数患者可能受益于通过有限的左侧侧胸切开术联合上半胸骨切开术或前右侧胸切开术进行的微创 LVAD 植入。在需要更换泵或取出泵的情况下，也可以考虑使用开胸术。这些技术的成功主要基于 LVAD 泵设计、流入管插入和流出移植物以及驱动线出口部位的优化。LVAD 领域的未来方向可能包括微创方法和智能技术。
