From extracorporeal membrane oxygenation to ventricular assist device oxygenation without sternotomy

摘要

From a technical standpoint, an 8-cm left anterior minithoracotomy is performed in the fifth or sixth intercostal space, depending on the LV shape and volume. The superficial pectoral fascia and the pectoralis major muscle are divided. The pectoralis minor muscle and a portion of the serratus anterior muscle are sectioned. The apex of the patient's LV is exposed by opening the pericardium anteriorly to the phrenic nerve. An apical cannula is positioned transcutaneously, inserted into the LV after a cross-blade incision, and secured by interrupted mattress sutures. After conventional deairing maneuvers, the cannula is then connected to the venous line of the ECMO circuit using a Y-shaped connector. LV drainage can then be started by draining blood from the LV apex and completely venting the left heart (Figure IB).