A Case Report of Minimally Invasive Left Ventricular Assist Device (LVAD) Implantation

LVAD therapy (implantation of a long-term mechanical left ventricular support device) is an adjunct (bridge therapy) or alternative (permanent therapy) to heart transplantation. In particular, the advantages of using minimally invasive approaches during LVAD implantation are known in world practice.

A serious limiting factor of LVAD therapy is still the low awareness of doctors and patients about this treatment method due to its long unavailability in our country.

Aim:1) to report on the successful implantation of LVAD from mini-thoracotomy to a patient with terminal chronic heart failure as a bridge therapy to heart transplantation, 2) to discuss the advantages and disadvantages of both LVAD therapy and the use of mini-thoracotomy, and 3) to identify key prognostic factors contributing to the positive outcome of such operations.

Materials and methods. We present a clinical case of surgical treatment of a patient with dilated cardiomyopathy who underwent implantation of a long-term mechanical left ventricular support device from a mini-thoracotomy. LVAD therapy was indicated to a patient with severe chronic heart failure who was on the waiting list for a heart transplant, and was performed as planned as bridge therapy against the background of the first signs of decompensation and incipient deterioration of right ventricular function.

Results. The patient is compliant, takes adequate care of the device, successfully takes warfarin according to the target range of INR, and regularly visits the hospital for follow-up examinations. He is waiting for the next stage of therapy, a heart transplant.

Conclusions. LVAD therapy from mini-thoracotomy is a safe, effective and reproducible method of surgical treatment of terminal CHF. The use of modern LVAD devices of the third generation, combined with competent and timely patient selection, makes it possible to increase survival and reduce the incidence of complications. The use of mini-thoracotomy, in addition to the general advantages of minimally invasive surgery, is especially indicated for patients.

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