My HeartWare implantation technique: tricks and pitfalls.

The rotary blood pump (the HeartWare® Ventricular Assist Device) from HeartWare® (Medtronic) is an established left ventricular assist device and usually implanted via sternotomy. To reduce the invasiveness of the implant procedure and to optimize the position of the inflow cannula, we propose an alternative implant technique with an extrapericardial placement of the pump via left anterolateral minithoracotomy. However, the minimally invasive approach is not suitable in patients in need of an additional cardiac procedure or with thrombus formation in the left atrial appendix. Preservation of the pericardium may reduce adhesions in future surgery such as heart transplantation, and an 'off pump' thoracotomy approach is feasible in patients without intraventricular thrombus.