Complications of minimally invasive left Ventricular assistance: a case report and review of the literature

Mleyhi Sobhi*, Radu Costin & Couetil Jean Paul

Ventricular assistance concerns patients with advanced cardiac failure in whom maximal medical and surgical treatment has been used. The ventricular assistance has two main purposes: first, to maintain circulation by discharging the ventricle (s) to provide recovery, and second to ensure patient survival by replacing cardiac function permanently or transitionally for patients waiting for cardiac Transplantation. The encouraging results of the partial or total artificial heart and the miniaturization of these devices allow their use in permanent implantation for patients with cardiac insufficiency that is not eligible for transplantation. In left mono-ventricular assistance, blood is taken from a cannula placed at the apex of the left ventricle (LV) and returned to the patient by an anastomosed vascular prosthesis with the ascending aorta. The classic surgical approach is a total median sternotomy. Other minimally invasive approaches for the implantation or explanation of left ventricular assist devices have been published and have shown encouraging results. These alternatives currently play an important role in certain indications and in patients with heavy medical history. Nevertheless, the complications of the ventricular assistance even by minimally invasive approaches might be serious and represent a turning point in the life of the patients. We describe the implantation of a left ventricular assistance using HeartMate II device by left under costal and high mini sternotomy approach in a tridux patient with permeable coronary bypasses and we discuss its postoperative evolution.