A right thoracotomy approach for the cannulation of biventricular assist device-A preclinical cadaver fitting trial

초록

Background: A median sternotomy has been a standard surgical technique for the cannulations of biventricular assist device. We studied a new technique of a right thoracotomy approach in human cadavers. Methods: In the study, a total of six cadavers were used. In 3 cadavers, a right thoracotomy was made along the fourth intercostal space. The right atrium and aorta were directly approached as routine. For the right-side outflow, the cannula was inserted through the right pulmonary artery by using the Seldinger technique. For the left-side inflow, the cannula was introduced into the left atrium below the interatrial groove between the right superior and inferior pulmonary veins, as in mitral valve surgery. In 2 cadavers, en- bloc resection of the anterior chest wall including both ventricles was made, and the same cannulation technique was applied described above. A median sternotomy with a conventional cannulation technique was made in 1 cadaver as a control. Results: The cannulations through the right lateral approach were simple and reproducible. The cadavers with en- bloc resection clearly demonstrated the well-positioned cannula tips in the main pulmonary artery as well as in the left atrial chamber. Conclusions: Considering most of the patients with end-stage heart failure have a previous sternotomy wound or need other cardiac procedures, our technique can avoid a sternotomy-related morbidity and mortality.

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