{"paper_id":"3bbccf35-8d8a-4a0c-8fcb-1a112c73f45f","body_text":"Minimally Invasive LVAD Implantation for Advanced Heart Failure: A Single-Center Retrospective Analysis and the Promise of Minimally Invasive Approaches | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Minimally Invasive LVAD Implantation for Advanced Heart Failure: A Single-Center Retrospective Analysis and the Promise of Minimally Invasive Approaches Qingpeng Wang, Jie Cai, Wenjun Yu, Wei Wang, Xing Chen, Jinping Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6721233/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract Objective This retrospective analysis reveals the clinical experience and technical advantages of minimally invasive left ventricular assist device (LVAD) implantation for patients with advanced heart failure. It highlights our single-center experience and discusses the potential of minimally invasive LVAD implantation, offering promising insights. Methods Our team evaluated patients who met the criteria for LVAD implantation surgery. We performed minimally invasive LVAD implantation for these patients and compared their cardiac function, intraoperative conditions, hemodynamics, and perioperative complications before and after the surgery. We used SPSS 26.0 software to statistically analyze the technical advantages of minimally invasive LVAD implantation. Results Within three months, a total of three patients underwent minimally invasive LVAD implantation surgery, all of whom were male, with a median age of 55.33 years [IQR:36.00–74.00 years]. The median body mass index was 26.90 [IQR:24.70–30.30]. All three patients (100%) were diagnosed with ischemic cardiomyopathy. Among them, 33.33% (1/3) had hypertension, 66.67% (2/3) had coronary artery disease, and 100% (3/3) were classified as NYHA class IV. Additionally, 33.33% (1/3) had aortic disease, 33.33% (1/3) had an INTERMACS score of 1, and 66.67% (2/3) had an INTERMACS score of 3. Preoperatively, 33.33% (1/3) of the patients were on both IABP and ECMO, while 100% (3/3) received positive inotropic agents, and all patients (3/3) had valve regurgitation. The median surgical time was 311.67 minutes [IQR:240.00-380.00 minutes], with a median intraoperative blood loss of 533.33 ml [IQR:500–600 ml] and a median cardiopulmonary bypass time of 169.00 minutes [IQR:121.00-214.00 minutes]. Postoperatively, the median duration of mechanical ventilation was 3.00 days [IQR:1.00–5.00 days], and the median ICU stay was 5.00 days [IQR:3.00–7.00 days]. Perioperative complications included arrhythmias in 33% (1/3), thrombosis in 0% (0/3), re-thoracotomy in 0% (0/3), and gastrointestinal bleeding in 0% (0/3). The 30-day mortality rate was 0% (0/3), while the six-month survival rate was 100% (3/3). Conclusion The implantation of a minimally invasive LVAD for the treatment of advanced heart failure is a safe and effective surgical method that can improve symptoms, reduce complications, lower the risk of perioperative right heart failure, and enhance early survival rates. Minimally Invasive LAVD Retrospective Study Key findings The minimally invasive LVAD implantation for the treatment of advanced heart failure highlight its safety and effectiveness. What is known and what is new? The clinical application of LVADs in the field of heart failure has shown rapid growth. Traditional open-chest surgery has been the standard approach for LVAD implantation, but it is associated with significant surgical trauma and longer recovery times. The minimally invasive LVAD implantation reduces operative time and blood loss. And it has a lower incidence of postoperative complications, such as infections and respiratory issues, compared to traditional open-chest procedures. Additionally, our patients reported faster recovery and improved quality of life, with shorter hospital stays and quicker return to normal activities. These findings suggest that minimally invasive LVAD implantation not only offers technical advantages but also significant clinical benefits for patients with advanced heart failure. What is the implication, and what should change now? Minimally invasive implantation of LVAD can improve symptoms, reduce complications, lower the risk of perioperative right heart failure, and enhance early survival rates. 1. INRODUCTION Left ventricular assist device (LVAD) is an artificial mechanical device that draws blood from the venous system or the heart and directly pumps it into the arterial system, partially or completely replacing the work of the ventricle. It is primarily used for supportive treatment before cardiac function recovery, as a transitional support treatment before heart transplantation, and for providing permanent assistance to patients who are not suitable for heart transplant[ 1 , 2 ].In recent years, the clinical application of LVADs in the field of heart failure has shown rapid growth. Median sternotomy is the classic and currently mainstream surgical method for LVAD implantation, with the main advantages being ease of operation under direct vision, preservation of the pericardium, and reduced adhesion of surrounding tissues; however, it is undeniable that this method is associated with significant trauma, substantial bleeding, and prolonged hospital stays. With the development of minimally invasive cardiac surgery and improvements in LVAD pumps, minimally invasive LVAD implantation has gradually become an inevitable trend in clinical development and a pressing need for patients[ 3 – 6 ].Minimally invasive LVAD implantation can maintain the integrity of the sternum, reduce intraoperative bleeding[ 7 , 8 ], lower the risk of postoperative infection, decrease the risk of right heart failure during the perioperative period[ 9 ], and improve early survival rates among patients[ 10 ]. Additionally, it preserves more possibilities for future heart transplantation [ 11 , 12 ]or other cardiac surgeries. The Cardiovascular Surgery Department of Zhongnan Hospital of Wuhan University successfully completed three cases of minimally invasive LVAD implantation for advanced heart failure from August to November in 2024. The purpose of this retrospective analysis from our center is to share the clinical experience and technical advantages of three cases of minimally invasive LVAD implantation in patients with advanced heart failure. 2. METHODS 2.1 Patients This study was approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University and obtained informed consent from the patients. From August 2024 to November 2024, three patients with a primary diagnosis of advanced heart failure underwent minimally invasive left ventricular assist device (LVAD) implantation treatment in the cardiovascular surgery department of Zhongnan Hospital of Wuhan University, with clinical data sourced from case records. 2.2 Operative technique Our cardiac team, comprising experts from the Advanced Heart Failure Unit within the Department of Cardiovascular Surgery at Zhongnan Hospital of Wuhan University, in collaboration with cardiac surgeons, anesthesiologists, and ultrasound specialists, jointly diagnosed patients with end-stage refractory heart failure. Following the criteria for left ventricular assist device (LVAD) implantation[ 1 , 2 , 10 , 13 ]: ①patients with end-stage severe heart failure meeting heart transplantation criteria, NYHA class IV, who continue to experience progressive symptoms despite guideline-directed standard treatment for stage D heart failure[ 2 ];②those who are heavily dependent on positive inotropic agents, have received maximum doses of vasoactive drug therapy, and are severely reliant on intra-aortic balloon pump (IABP), circulatory support pump catheters, and external LVAD[ 14 ]༛③patients without severe right heart failure and significant tricuspid regurgitation;④those with progressive renal and/or liver function deterioration due to decreased perfusion rather than inadequate left ventricular filling pressure (pulmonary capillary wedge pressure ≥ 20 mmHg, and systolic blood pressure ≤ 80–90 mmHg or cardiac index ≤ 2 L•min-1•m-2). The patient was placed in a supine position under general anesthesia, with a single-lumen tracheal intubation. Intraoperative transesophageal echocardiography (TEE) indicated left atrial enlargement, generalized reduction in left ventricular wall motion amplitude, decreased left ventricular systolic function, formation of an apical ventricular aneurysm, and preserved right ventricular wall motion amplitude. Moderate regurgitant signals were observed at the mitral valve orifice, while no significant regurgitant signals were noted at the aortic valve orifice. Incisions were made in the left fifth intercostal space (from the midclavicular line to the anterior axillary line), the right second intercostal space (from the sternum to the midclavicular line), and the right groin (obliquely) to open the skin and subcutaneous tissue, reaching the left and right thoracic cavities and the femoral artery and vein on the right side. A 5 − 0 Prolene purse-string suture was placed on the right femoral artery and vein. The patient was systemically heparinized, and the position of the artificial heart pump was marked at the apex under esophageal ultrasound guidance. Cannulation of the right femoral artery and vein was performed for extracorporeal circulation, with a 3 − 0 Prolene purse-string suture securing the infusion needle at the root. A cruciate incision was made at the abdominal access point, and a cable was guided through. After occlusion of the ascending aorta, the root infusion needle was used to infuse Del Nido solution to induce cardiac arrest. A 3 − 0 Prolene suture with felt was used to intermittently secure the ventricular connector at the apex, followed by an apical incision to install the blood pump. The ascending aorta was opened for venting, and the heart resumed beating in a sinus rhythm. A side clamp was used to occlude part of the ascending aorta, and a 5 − 0 Prolene suture was used to anastomose the artificial blood vessel to the root of the ascending aorta, with intermittent reinforcement of the anastomosis using 5 − 0 Prolene and bovine pericardium. The blood pump was gradually started and vented. After venting the heart, the side clamp was released, and circulatory support was initiated, gradually transitioning to the artificial blood pump, set at 2600 rpm with a flow rate of 4.0 L/min, followed by adjustments for shutdown and removal of the extracorporeal cannula. Protamine was used to neutralize heparin, and vancomycin plus gentamicin were instilled into the pericardial cavity. Left and right chest tubes were placed, and routine closure of the chest was performed, followed by suturing of the subcutaneous tissue and skin. The procedure was smooth, and the patient was safely returned to the ICU after surgery. 2.3 Postoperative management Postoperatively, the patient was transferred to the Intensive Care Unit (ICU) for continued treatment and early extubation. The treatment included anti-infection therapy, management of left and right heart balance, positive inotropic support, diuretics, nutritional support, maintenance of organ function, and symptomatic support. 2.4 Statistical analysis Clinical data, ultrasound data, hemodynamic data, perioperative data, and surgical data from before and after the surgery were organized and analyzed using SPSS 26.0. Considering the sample size and the non-normal distribution of the data, the results are presented as medians and interquartile ranges. 3. RESULTS 3.1 Patient characteristics The preoperative clinical data of the patients are presented in Table 1 . Between August 2024 and November 2024, a total of three patients underwent minimally invasive left ventricular assist device (LVAD) implantation. The median age of the cohort was 55.33 years[interquartile range (IQR): 36.00–74.00 years], and all patients were male. The median body mass index (BMI) was 26.90[IQR: 24.70–30.30]. All patients were diagnosed with ischemic cardiomyopathy. Of these, 33.33% (1/3) had hypertension, 66.67% (2/3) had coronary artery disease, and all patients (100%) were classified as New York Heart Association (NYHA) class IV. Additionally, 33.33% (1/3) had aortic disease, 33.33% (1/3) had an INTERMACS score of 1, and 66.67% (2/3) had an INTERMACS score of 3. Furthermore, 33.33% (1/3) of the patients were concurrently using intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) prior to surgery, all patients (100%, 3/3) were on positive inotropic agents, and all (100%, 3/3) exhibited valvular regurgitation. Table 1 Patient's characteristics Clinical data Case 1 Case 2 Case 3 Total Gender Male Male Male 3(Male) Age(years) 74.00 56.00 36.00 55.33 ± 19.01 BMI(kg/m 2 ) 25.70 24.70 30.30 26.90 ± 2.99 Hypertension Y N N 33.33%(1/3) Diabetes N N N 0%(0/3) Hyperlipidemia N N N 0%(0/3) Coronary heart disease Y Y N 66.67%(2/3) NYHA Ⅳ Ⅳ Ⅳ 100%(3/3) Aortic disease Y N N 33.33%(1/3) Peripheral vascular disease N N N 0%(0/3) Cerebrovascular disease N N N 0%(0/3) Renal Diseases N N N 0%(0/3) Digestive System Diseases Y Y N 66.67%(2/3) Positive inotropic drug Y Y Y 100%(3/3) ICD N N N 0%(0/3) IABP Y Y N 66.67%(2/3) ECMO N Y N 33.33%(1/3) INTERMACS 3 1 3 - Smoking history N Y Y 66.67%(2/3) MR Severe Severe Moderate 100%(3/3) AR Mild Mild Mild 100%(3/3) TR Mild Mild Mild-Moderate 100%(3/3) Pulmonary hypertension N N Mild 33.33%(1/3) Y: Patients have this disease N༚Patients don’t have this disease 3.2 Preoperative and Postoperative hemodynamics Tables 2 – 3 display the hemodynamic and echocardiographic results before and after surgery. The preoperative median values were as follows: mean arterial pressure (MAP) at 83.33 mmHg [interquartile range (IQR): 76.00–95.00 mmHg], central venous pressure (CVP) at 14.66 mmHg [IQR: 9.00–24.00 mmHg], systolic pulmonary artery pressure (sPAP) at 42.66 mmHg [IQR: 29.00–50.00 mmHg], mean pulmonary artery pressure (mPAP) at 20.67 mmHg [IQR: 19.00–22.00 mmHg], pulmonary capillary wedge pressure (PCWP) at 18.66 mmHg [IQR: 12.00–27.00 mmHg], arterial oxygen saturation (SaO2) at 99.20% [IQR: 97.60–100.00%], mixed venous oxygen saturation (SvO2) at 57.53% [IQR: 50.00-72.60%], cardiac index (CI) at 3.33 L/min/m² [IQR: 2.60–3.90 L/min/m²], and cardiac output (CO) at 6.00 L/min [IQR: 5.00-6.70 L/min]. Postoperatively, the median values were as follows: MAP at 81.66 mmHg [IQR: 69.00–94.00 mmHg], CVP at 8.33 mmHg [IQR: 6.00–11.00 mmHg], sPAP at 34.33 mmHg [IQR: 30.00–39.00 mmHg], mPAP at 19.00 mmHg [IQR: 15.00–22.00 mmHg], PCWP at 25.00 mmHg [IQR: 22.00–28.00 mmHg], SaO2 at 99.67% [IQR: 99.00-100.00%], SvO2 at 51.66% [IQR: 49.00–54.00%], CI at 3.40 L/min/m² [IQR: 3.20–3.60 L/min/m²], and CO at 5.63 L/min [IQR: 5.10-6.00 L/min]. The echocardiographic assessment revealed that the median ejection fraction (EF) percentage of patients prior to surgery was 30.33% [interquartile range: 25.00–37.00%], while the median fractional shortening (FS) percentage was 14% [interquartile range: 11–18%]. The median left ventricular (LV) dimension was 5.97 mm [interquartile range: 5.50–6.70 mm], and the median right ventricular (RV) dimension was 4.36 mm [interquartile range: 3.70–4.90 mm]. All patients (100%, 3/3) demonstrated varying degrees of valvular regurgitation. Following surgical intervention, the median EF percentage increased to 42.33% [interquartile range: 36.00–46.00%], and the median FS percentage improved to 20.33% [interquartile range: 18.00–23.00%]. The median LV dimension decreased to 5.40 mm [interquartile range: 4.80–6.20 mm], and the median RV dimension reduced to 3.77 mm [interquartile range: 3.50-4.00 mm]. Notably, all patients (100%, 3/3) exhibited resolution of valvular regurgitation postoperatively. Table 2 Patient's Pre- and Post-operative hemodynamic parameters Preoperative Postoperative Case 1 Case 2 Case 3 Total Case 1 Case 2 Case 3 Total MAP(mmHg) 76.00 79.00 95.00 83.33 ± 10.21 69.00 94.00 82.00 81.66 ± 12.50 CVP(mmHg) 9.00 11.00 24.00 14.66 ± 8.14 8.00 11.00 6.00 8.33 ± 2.52 sPAP(mmHg) 29.00 49.00 50.00 42.66 ± 11.84 30.00 39.00 34.00 34.33 ± 4.51 mPAP(mmHg) 19.00 21.00 22.00 20.67 ± 1.53 20.00 22.00 15.00 19.00 ± 3.61 PCWP(mmHg) 17.00 12.00 27.00 18.66 ± 7.64 25.00 22.00 28.00 25.00 ± 3.00 SaO 2 97.60 100.00 100.00 99.20 ± 1.39 99.00 100.00 100.00 99.67 ± 0.58 SvO 2 50.00 72.60 50.00 57.53 ± 13.05 49.00 54.00 52.00 51.66 ± 2.52 CI 3.90 2.60 3.50 3.33 ± 0.67 3.20 3.60 3.40 3.40 ± 0.20 CO 6.70 5.00 6.30 6.00 ± 0.89 5.80 5.10 6.00 5.63 ± 0.47 Table 3 Patient's Pre- and Post-operative Echocardiographic Parameters Preoperative Postoperative Case 1 Case 2 Case 3 Total Case 1 Case 2 Case 3 Total LA(cm) 4.50 4.20 4.40 4.36 ± 0.15 4.40 4.00 4.60 4.33 ± 0.31 LV(cm) 5.70 5.50 6.70 5.97 ± 0.64 5.20 4.80 6.20 5.40 ± 0.72 IVS(cm) 1.30 1.10 1.20 1.20 ± 0.10 1.00 1.00 1.10 1.03 ± 0.06 LVPW 1.20 1.30 1.10 1.20 ± 0.10 1.00 1.10 1.10 1.07 ± 0.06 RA(cm) 5.00 4.60 4.50 4.70 ± 0.26 4.00 4.00 3.30 3.77 ± 0.40 RV(cm) 4.90 4.50 3.70 4.36 ± 0.61 3.50 4.00 3.80 3.77 ± 0.26 EF% 37.00 29.00 25.00 30.33 ± 6.11 46.00 45.00 36.00 42.33 ± 5.51 FS% 18.00 13.00 11.00 14.00 ± 3.61 23.00 20.00 18.00 20.33 ± 2.52 MVE(m/s) 1.20 1.10 1.10 1.13 ± 0.06 0.80 0.70 0.70 0.73 ± 0.06 AV(m/s) 1.20 1.10 0.80 1.03 ± 0.21 0.80 0.80 0.60 0.73 ± 0.12 PV(m/s) 0.80 0.80 0.70 0.77 ± 0.06 0.60 0.70 0.80 0.70 ± 0.10 PA(mmHg) 2.50 2.40 2.40 2.43 ± 0.06 2.30 2.30 2.30 2.30 ± 0.00 MR Severe Severe Moderate - N N N - AR Mild Mild Mild - N N N - TR Mild Mild Mild-Moderate - N N N - Y: Patients have this disease N༚Patients don’t have this disease 3.3 Operation and clinical results The surgical and postoperative complications are comprehensively presented in Table 4 . One patient underwent closure of a patent foramen ovale in conjunction with ECMO weaning and the implementation of an intra-aortic balloon pump, whereas another patient underwent closure of a patent foramen ovale combined with left atrial appendage occlusion. The median surgical duration was 311.67 minutes [IQR: 240.00-380.00min]. The median intraoperative blood loss was 533.33 ml [IQR: 500.00-600.00ml], and the median duration of cardiopulmonary bypass was 169.00 minutes [IQR: 121.00-214.00min]. Postoperatively, the median duration of mechanical ventilation was 3.00 days [IQR: 1.00-5.00days], and the median length of stay in the ICU was 5.00 days [IQR: 3.00-7.00days]. Perioperative complications included arrhythmias in 33% of patients (1/3), with no occurrences of thrombus formation, re-thoracotomy, or gastrointestinal bleeding (0 /3). The 30-day mortality rate was 0% (0/3), and the six-month survival rate was 100% (3/3). Table 4 Patient's intraoperative and postoperative parameters Case 1 Case 2 Case 3 Total LVAD Type Corheart® 6 Corheart® 6 CH-VAD - Operation Time(min) 240.00 315.00 380.00 311.67 ± 70.06 Cardiopulmonary Bypass Time(min) 121.00 172.00 214.00 169.00 ± 46.57 Aortic Occlusion Time(min) 49.00 64.00 111.00 74.67 ± 32.35 Intraoperative Blood Loss(ml) 600.00 500.00 500.00 533.33 ± 57.74 ICU Time(days) 5.00 7.00 3.00 5.00 ± 2.00 Duration of Mechanical Ventilation (Days) 3.00 5.00 1.00 3.00 ± 2.00 Postoperative Complications N N N 0(0/3) Death N N N 0(0/3) Arrhythmia N Y N 1(1/3) Secondary Thoracotomy N N N 0(0/3) Gastrointestinal Bleeding N N N 0(0/3) Thrombosis N N N 0(0/3) Y: Patients have this disease N༚Patients don’t have this disease 4. DISCUSSION The conventional implantation of a left ventricular assist device (LVAD) is typically conducted via a median sternotomy accompanied by cardiac arrest, representing the standard surgical method in contemporary practice. This method provides excellent surgical exposure for the implanted pump, maintains complete coverage of the heart during the procedure, reduces adhesion to surrounding tissues, ensures hemodynamic stability, allows for thorough examination of the left heart structures, facilitates venting, and can correct intracardiac abnormalities simultaneously. However, it is undeniable that this technique is highly invasive, associated with significant intraoperative bleeding, a high risk of infection, and prolonged hospital stays for patients. Additionally, it carries risks such as blood dilution, coagulation dysfunction, systemic inflammatory response, increased pulmonary artery pressure, and right heart failure[ 15 ]. With the development of minimally invasive cardiac surgery and the miniaturization of third-generation LVAD pumps, minimally invasive LVAD implantation techniques have become a trend in clinical practice and a pressing need for patients[ 3 – 5 , 16 – 20 ]. In three instances of minimally invasive left ventricular assist device (LVAD) implantation successfully conducted at our center, metrics including surgical duration, anesthesia duration, extracorporeal circulation time, blood loss, length of ICU stay, and duration of mechanical ventilation were all significantly shortened or improved compared to traditional open-heart surgery. During the surgical procedure, We found that compared to conventional open-heart surgery[ 16 ], minimally invasive LVAD implantation not only preserves the integrity of the sternum and allows for the LVAD pump to be implanted through a small incision[ 16 , 21 ], thereby minimizing surgical trauma, but also effectively avoids myocardial ischemia-reperfusion injury, reduces intraoperative blood loss and the use of blood products [ 7 , 8 ]and shortens the duration of positive inotropic drug use[ 8 , 22 ], while decreasing the risk of wound infection[ 21 ]. Additionally, after the surgery, we also found that the patient's sternum remained intact, with only a 2-centimeter incision under the left rib. It preserves more anatomical options for future heart transplantation or other cardiac surgeries. Postoperatively, patients recover well and can mobilize early[ 23 ], shortening the recovery period and hospital stay[ 22 , 24 ]. Furthermore, it is learned that the implantation of the LVAD pump provides stable hemodynamic support to maintain the function of terminal organs[ 25 ]and can also be used for support therapy prior to cardiac function recovery, transitional support therapy while waiting for heart transplantation[ 12 , 26 ]and permanent assistive treatment for patients who are not suitable candidates for heart transplantation[ 11 ].The minimally invasive implantation of LVAD can be conducted while the heart remains beating[ 27 , 28 ], a technique that significantly mitigates cardiac damage, reduces perioperative complications, and enhances long-term outcomes. Moreover, maintaining cardiac activity ensures adequate filling of the left ventricle. Additionally, we use a left intercostal incision can enhance apical suspension, thereby facilitating more effective gas evacuation and reducing the risk of gas embolism during the perioperative period. Importantly, we think that one of the most challenging issues associated with LVAD implantation is the postoperative balance between the left and right heart[ 26 , 29 ], This includes problems such as changes in preload and afterload, increased right ventricular pressure, fluid imbalance, hemodynamic monitoring, and uneven mechanical loading[ 26 ]. However, minimally invasive LVAD implantation can reduce the risk of right heart failure during the perioperative period[ 9 , 26 , 30 – 32 ], mainly for the following reasons: (1) Minimally invasive surgical techniques use smaller incisions, reducing mechanical damage to the thoracic cavity and heart, which helps protect right heart function. (2) During the surgery, intraoperative ultrasound and observation of hemodynamic parameters allow for timely assessment of cardiac function, enabling adjustments to LVAD parameters to optimize blood flow balance between the left and right heart[ 25 ].(3) Based on the specific cardiac function status of the patient, the speed of the LVAD can be adjusted to ensure that blood flow meets the body’s needs, thereby reducing the burden on the right heart. (4) Minimally invasive techniques decrease the incidence of perioperative complications[ 33 ], lowering the risk of postoperative right heart failure and thus facilitating the balance of cardiac function[ 34 ].(5) Postoperatively, closely monitoring and managing the patient's fluid status, medication use, and cardiac function evaluation helps maintain overall cardiac balance. (6) Patients typically recover quickly after minimally invasive surgery, but attention must still be paid to the burden on the right heart, optimizing fluid intake, medication, and rehabilitation plans to maintain overall cardiac function. Minimally invasive LVAD implantation surgery effectively enhances the likelihood of achieving balance between the left and right heart by reducing trauma and complications, combined with personalized management approaches[ 30 ].This represents a significant advancement in the field of cardiac surgery in recent years. Minimally invasive LVAD implantation can also improve early survival rates for patients[ 35 ], particularly for critically ill patients with advanced heart failure[ 35 ], we had completed three cases: the elderly and those with high body weight[ 36 , 37 ], as well as patients on IABP + ECMO[ 14 ].This procedure effectively reduces perioperative complications for these patients, including the risks of postoperative infection, bleeding, and other complications[ 33 ].Due to the smaller incision, patients typically recover faster and return to their daily lives more quickly, which helps improve postoperative survival rates. Minimally invasive LVAD surgery can support cardiac function earlier, reduce the burden of heart failure, and rapidly improve the patient's hemodynamic status, promoting the recovery of multiple organ functions. Real-time monitoring of hemodynamic changes during the procedure aids in timely adjustments to LVAD parameters, providing stable blood flow, reducing cardiac load, and preventing the worsening of heart failure. In minimally invasive surgeries, doctors can develop more personalized surgical and postoperative management plans based on the specific conditions of the patient, optimizing efficacy and minimizing risks. The advantages of minimally invasive surgery include shorter hospital admission and stay times, which contribute to the recovery of mental health, while also alleviating the economic burden and psychological stress on patients and their families, thereby enhancing the overall survival capacity of patients. Therefore, minimally invasive LVAD implantation offers a safer and more effective treatment option for critically ill patients with advanced heart failure, significantly improving early survival rates[ 38 ]. However, consistent with the results reported by most centers, there is no significant difference in mid- to long-term survival rates between minimally invasive and median sternotomy approaches[ 7 , 33 ],The purpose of this article is to analyze the technical advantages and clinical experience of minimally invasive LVAD implantation. With the development of minimally invasive cardiac surgery and the improvement and updating of LVAD pumps, minimally invasive LVAD implantation techniques are gradually becoming a trend in clinical practice and a practical need for patients[ 5 , 6 ].Compared to traditional open-heart surgery, the learning curve for minimally invasive LVAD implantation techniques is long and the learning difficulty is high [ 39 – 41 ], This approach requires a well-coordinated team and highly specialized skills[ 41 ], and it emphasizes the importance of preoperative technical planning as well as postoperative care and monitoring. As long as the team is experienced, the skills are proficient, there is sufficient multidisciplinary discussion before the operation, tight monitoring during the procedure to reduce risks, and enhanced care after surgery, minimally invasive LVAD implantation remains a safe, effective, and feasible method for treating advanced heart failure[ 19 , 33 , 42 ]. 5. CONCLUSIONS The implantation of a minimally invasive LVAD for patients with advanced heart failure is a safe and effective surgical method that can improve symptoms, reduce complications, lower the risk of perioperative right heart failure, and enhance early survival rates. 6. LIMITATIONS The limitations of this study include a small number of cases, a short follow-up period, and the lack of comparative analysis between patients undergoing open chest and minimally invasive surgery. Declarations ACKNOWLEDGMENTS This research was supported by the National Natural Science Foundation of China (No. 82470421). We declare that this manuscript has not been published elsewhere, in whole or in part, and has not been presented at any scientific meeting, including in abstract form. AUTHOR CONTRIBUTIONS (I) Conception and design: Chen Xing and Liu Jinping;(II) Administrative support: Liu Jinping;(III) Provision of study materials or patients: Cai Jie and Yu Wenjun;(IV) Collection and assembly of data: Wang Qingpeng and Wang Wei;(V) Data analysis and interpretation: Wang Qingpeng;(VI) All authors contributed to the manuscript writing and final approval of manuscript. CONFLICT OF INTEREST STATEMENT The authors declare that there are no conflicts of interest regarding the publication of this article, including among co-authors. All authors have agreed to publish this article in the Journal of Cardiothoracic Surgery . DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. 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Pasrija C, Sawan MA, Sorensen E, Voorhees H, Shah A, Strauss E, Ton V-K, DiChiacchio L, Kaczorowski DJ, Griffith BP, et al. Less invasive left ventricular assist device implantation may reduce right ventricular failure. Interact Cardiovasc Thorac Surg. 2019;29(4):592–8. Monteagudo Vela M, Rial Bastón V, Panoulas V, Riesgo Gil F, Simon A. A detailed explantation assessment protocol for patients with left ventricular assist devices with myocardial recovery. Interact Cardiovasc Thorac Surg. 2021;32(2):298–305. Rabin J, Ziegler LA, Cipriano S, Madathil RJ, Feller ED, Sorensen EN, Griffith BP, Kaczorowski DJ. Minimally Invasive Left Ventricular Assist Device Insertion Facilitates Subsequent Heart Transplant. Innovations (Phila). 2021;16(2):157–62. Ziegler LA, Bittle GJ, Klass WJ, Sorensen EN, Madathil RJ, Feller ED, Griffith BP, Kaczorowski DJ. A Minimally Invasive Approach to Left Ventricular Assist Device Insertion Facilitates Subsequent Explant. Innovations (Phila). 2021;16(1):104–7. Correction to. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;147(14):e674. Sabashnikov A, Popov A-F, Bowles CT, Mohite PN, Weymann A, Hards R, Hedger M, Wittwer T, Wippermann J, Wahlers T et al. Outcomes after implantation of partial-support left ventricular assist devices in inotropic-dependent patients: Do we still need full-support assist devices? J Thorac Cardiovasc Surg 2014, 148(3). Lampert BC, Teuteberg JJ, Cowger J, Mokadam NA, Cantor RS, Benza RL, Ganapathi AM, Myers SL, Hiesinger W, Woo J, et al. Impact of thoracotomy approach on right ventricular failure and length of stay in left ventricular assist device implants: an intermacs registry analysis. J Heart Lung Transpl. 2021;40(9):981–9. Al-Naamani A, Fahr F, Khan A, Bireta C, Nozdrzykowski M, Feder S, Deshmukh N, Jubeh M, Eifert S, Jawad K, et al. Minimally invasive ventricular assist device implantation. J Thorac Dis. 2021;13(3):2010–7. Wiedemann D, Haberl T, Angleitner P, Dimitrov K, Laufer G, Zimpfer D. Minimally invasive approaches for implantation of left ventricular assist devices. Indian J Thorac Cardiovasc Surg. 2018;34(Suppl 2):177–82. Wachter K, Franke UFW, Rustenbach CJ, Baumbach H. Minimally Invasive versus Conventional LVAD-Implantation-An Analysis of the Literature. Thorac Cardiovasc Surg. 2019;67(3):156–63. Makdisi G, Wang IW. Minimally invasive is the future of left ventricular assist device implantation. J Thorac Dis. 2015;7(9):E283–8. Molina EJ, Boyce SW. Current status of left ventricular assist device technology. Semin Thorac Cardiovasc Surg. 2013;25(1):56–63. Gerhard EF, Wang L, Singh R, Schueler S, Genovese LD, Woods A, Tang D, Smith NR, Psotka MA, Tovey S, et al. LVAD decommissioning for myocardial recovery: Long-term ventricular remodeling and adverse events. J Heart Lung Transpl. 2021;40(12):1560–70. Ribeiro RVP, Lee J, Elbatarny M, Friedrich JO, Singh S, Yau T, Yanagawa B. Left ventricular assist device implantation via lateral thoracotomy: A systematic review and meta-analysis. J Heart Lung Transpl. 2022;41(10):1440–58. Ayers BC, Bjelic M, Wood K, Sheen S, Morrison E, Prasad S, Gosev I. Complete sternal-sparing left ventricular assist device implantation is associated with improved postoperative mobility. Interact Cardiovasc Thorac Surg. 2021;32(6):878–81. Zaky M, Nordan T, Kapur NK, Vest AR, DeNofrio D, Chen FY, Couper GS, Kawabori M. Impella 5.5 Support Beyond 50 Days as Bridge to Heart Transplant in End-Stage Heart Failure Patients. ASAIO J. 2023;69(4):e158–62. Schaefer A, Reichart D, Bernhardt AM, Kubik M, Barten MJ, Wagner FM, Reichenspurner H, Philipp SA, Deuse T. Outcomes of Minimally Invasive Temporary Right Ventricular Assist Device Support for Acute Right Ventricular Failure During Minimally Invasive Left Ventricular Assist Device Implantation. ASAIO J. 2017;63(5):546–50. Saeed D, Muslem R, Rasheed M, Caliskan K, Kalampokas N, Sipahi F, Lichtenberg A, Jawad K, Borger M, Huhn S, et al. Less invasive surgical implant strategy and right heart failure after LVAD implantation. J Heart Lung Transpl. 2021;40(4):289–97. Cheung A, Bashir J, Kaan A, Kealy J, Moss R, Shayan H. Minimally invasive, off-pump explant of a continuous-flow left ventricular assist device. J Heart Lung Transpl. 2010;29(7):808–10. Lewin D, Rojas SV, Billion M, Meyer AL, Netuka I, Kooij J, Pieri M, Loforte A, Szymanski MK, Moeller CH, et al. Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life support. JTCVS Open. 2024;21:168–79. Løgstrup BB, Nemec P, Schoenrath F, Gummert J, Pya Y, Potapov E, Netuka I, Ramjankhan F, Parner ET, De By T, et al. Heart failure etiology and risk of right heart failure in adult left ventricular assist device support: the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). Scand Cardiovasc J. 2020;54(5):306–14. Adamopoulos S, Bonios M, Ben Gal T, Gustafsson F, Abdelhamid M, Adamo M, Bayes-Genis A, Böhm M, Chioncel O, Cohen-Solal A et al. Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024. Carmona A, Hoang Minh T, Perrier S, Schneider C, Marguerite S, Ajob G, Mircea C, Mertes P-M, Ramlugun D, Atlan J, et al. Minimally invasive surgery for left ventricular assist device implantation is safe and associated with a decreased risk of right ventricular failure. J Thorac Dis. 2020;12(4):1496–506. Mohite PN, Sabashnikov A, Raj B, Hards R, Edwards G, García-Sáez D, Zych B, Husain M, Jothidasan A, Fatullayev J, et al. Minimally Invasive Left Ventricular Assist Device Implantation: A Comparative Study. Artif Organs. 2018;42(12):1125–31. Reichart D, Brand CF, Bernhardt AM, Schmidt S, Schaefer A, Blankenberg S, Reichenspurner H, Wagner FM, Deuse T, Barten MJ. Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience. Thorac Cardiovasc Surg. 2019;67(3):170–5. Wert L, Chatterjee A, Dogan G, Hanke JS, Boethig D, Tümler KA, Napp LC, Berliner D, Feldmann C, Kuehn C, et al. Minimally invasive surgery improves outcome of left ventricular assist device surgery in cardiogenic shock. J Thorac Dis. 2018;10(Suppl 15):S1696–702. Pasrija C, Sawan MA, Sorensen E, Voorhees HJ, Shah A, Wang L, Ton V-K, DiChiacchio L, Kaczorowski DJ, Griffith BP, et al. Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients. Innovations (Phila). 2020;15(3):243–50. Bjelic M, Ayers B, Paic F, Bernstein W, Barrus B, Chase K, Gu Y, Alexis JD, Vidula H, Cheyne C, et al. Study results suggest less invasive HeartMate 3 implantation is a safe and effective approach for obese patients. J Heart Lung Transpl. 2021;40(9):990–7. Jeng EI, Miller AH, Friedman J, Tapia-Ruano SA, Reilly K, Parker A, Vilaro J, Aranda JM, Klodell CT, Beaver TM, et al. Ventricular Assist Device Implantation and Bariatric Surgery: A Route to Transplantation in Morbidly Obese Patients with End-Stage Heart Failure. ASAIO J. 2021;67(2):163–8. Schmitto JD, Rojas SV, Hanke JS, Avsar M, Haverich A. Minimally invasive left ventricular assist device explantation after cardiac recovery: surgical technical considerations. Artif Organs. 2014;38(6):507–10. Özer T, Gunay D, Hancer H, Altas Yerlikhan O, Ozgur MM, Aksut M, Sarikaya S, Kirali K. Transition from Conventional Technique to Less Invasive Approach in Left Ventricular Assist Device Implantations. ASAIO J. 2020;66(9):1000–5. Robinson D, Fitzsimmons M, Waters K, Mohiuddin F, Knight P, Sauer J Jr, Gosev CJ. A novel model for minimally invasive left ventricular assist device implantation training. Minim Invasive Ther Allied Technol. 2020;29(4):194–201. Zhang L-F, Feng H-B, Yu Z-G, Jing S, Wan F. Surgical Training Improves Performance in Minimally Invasive Left Ventricular Assist Device Implantation Without Cardiopulmonary Bypass. J Surg Educ. 2018;75(1):195–9. Cheung A, Soon J-L, Bashir J, Kaan A, Ignaszewski A. Minimal-access left ventricular assist device implantation. Innovations (Phila). 2014;9(4):281–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Dec, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 25 Sep, 2025 Reviews received at journal 29 Jul, 2025 Reviews received at journal 26 Jul, 2025 Reviews received at journal 20 Jul, 2025 Reviewers agreed at journal 16 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviewers invited by journal 15 Jul, 2025 Editor assigned by journal 22 May, 2025 Submission checks completed at journal 22 May, 2025 First submitted to journal 22 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6721233\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":486508341,\"identity\":\"b9859666-e977-40d6-b1ac-862414e5d25d\",\"order_by\":0,\"name\":\"Qingpeng Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Qingpeng\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":486508342,\"identity\":\"e9325cfc-36a8-4db9-aa9a-e16179c28346\",\"order_by\":1,\"name\":\"Jie Cai\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jie\",\"middleName\":\"\",\"lastName\":\"Cai\",\"suffix\":\"\"},{\"id\":486508343,\"identity\":\"76cbed30-9f41-4196-9d28-ca8c32e5ebbf\",\"order_by\":2,\"name\":\"Wenjun Yu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Wenjun\",\"middleName\":\"\",\"lastName\":\"Yu\",\"suffix\":\"\"},{\"id\":486508344,\"identity\":\"f833a0b1-418a-4d7e-a010-3c85a5f5de25\",\"order_by\":3,\"name\":\"Wei Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Wei\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":486508345,\"identity\":\"a0d2ca8e-bf32-4b77-b91a-eb2e8bca714b\",\"order_by\":4,\"name\":\"Xing Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xing\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"},{\"id\":486508346,\"identity\":\"26b30fa8-a2d0-4d08-b1fd-d9946087f544\",\"order_by\":5,\"name\":\"Jinping Liu\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIie3Qv2vCQBTA8RcenMvFWzv4R7wi+APE/CsXAh2LxaWjINzUP6D9HzpkEt0it6a4OjhEBLeCkKXd+oxCXJI4drjvEI4HH95dAFyuf1gbAUgDSABMwJvxiCeQ1RBREqGvhEe6jpRHSRcCTaQlabJf7jp99ZnnL8tR0G+p9UnD+Ln6YpIoTI9y+P4ddz/Sp3A1R3zQEE3ribGStl9x5BurySIwScJZM0kzyyRggj/3kc2bN2fixRZFwxYxYXLkLaKLvine0htoiiqJUnbx+Gt2AW3sIfcN/zG1PmxPr+NKcl5EAAmcn1xEN9+qMCuISm6Jy+Vyucr+AOAgVD3GADUbAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Jinping\",\"middleName\":\"\",\"lastName\":\"Liu\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-05-22 05:08:23\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6721233/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6721233/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s13019-025-03815-x\",\"type\":\"published\",\"date\":\"2025-12-29T15:57:27+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":99545441,\"identity\":\"924bed24-3e8f-43c1-a597-fb9d1be6c86d\",\"added_by\":\"auto\",\"created_at\":\"2026-01-05 16:07:40\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":913640,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6721233/v1/16de40f4-3a46-44db-8fa0-d61ae0c75182.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Minimally Invasive LVAD Implantation for Advanced Heart Failure: A Single-Center Retrospective Analysis and the Promise of Minimally Invasive Approaches\",\"fulltext\":[{\"header\":\"Key findings\",\"content\":\"\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eThe minimally invasive LVAD implantation for the treatment of advanced heart failure highlight its safety and effectiveness.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWhat is known and what is new?\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eThe clinical application of LVADs in the field of heart failure has shown rapid growth. Traditional open-chest surgery has been the standard approach for LVAD implantation, but it is associated with significant surgical trauma and longer recovery times.\\u003c/li\\u003e\\n \\u003cli\\u003eThe minimally invasive LVAD implantation reduces operative time and blood loss. And it has a lower incidence of postoperative complications, such as infections and respiratory issues, compared to traditional open-chest procedures. Additionally, our patients reported faster recovery and improved quality of life, with shorter hospital stays and quicker return to normal activities. These findings suggest that minimally invasive LVAD implantation not only offers technical advantages but also significant clinical benefits for patients with advanced heart failure.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWhat is the implication, and what should change now?\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eMinimally invasive implantation of LVAD can improve symptoms, reduce complications, lower the risk of perioperative right heart failure, and enhance early survival rates.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"1. INRODUCTION\",\"content\":\"\\u003cp\\u003eLeft ventricular assist device (LVAD) is an artificial mechanical device that draws blood from the venous system or the heart and directly pumps it into the arterial system, partially or completely replacing the work of the ventricle. It is primarily used for supportive treatment before cardiac function recovery, as a transitional support treatment before heart transplantation, and for providing permanent assistance to patients who are not suitable for heart transplant[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].In recent years, the clinical application of LVADs in the field of heart failure has shown rapid growth. Median sternotomy is the classic and currently mainstream surgical method for LVAD implantation, with the main advantages being ease of operation under direct vision, preservation of the pericardium, and reduced adhesion of surrounding tissues; however, it is undeniable that this method is associated with significant trauma, substantial bleeding, and prolonged hospital stays. With the development of minimally invasive cardiac surgery and improvements in LVAD pumps, minimally invasive LVAD implantation has gradually become an inevitable trend in clinical development and a pressing need for patients[\\u003cspan additionalcitationids=\\\"CR4 CR5\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].Minimally invasive LVAD implantation can maintain the integrity of the sternum, reduce intraoperative bleeding[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e], lower the risk of postoperative infection, decrease the risk of right heart failure during the perioperative period[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], and improve early survival rates among patients[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Additionally, it preserves more possibilities for future heart transplantation [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]or other cardiac surgeries. The Cardiovascular Surgery Department of Zhongnan Hospital of Wuhan University successfully completed three cases of minimally invasive LVAD implantation for advanced heart failure from August to November in 2024. The purpose of this retrospective analysis from our center is to share the clinical experience and technical advantages of three cases of minimally invasive LVAD implantation in patients with advanced heart failure.\\u003c/p\\u003e\"},{\"header\":\"2. METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.1 Patients\\u003c/h2\\u003e\\u003cp\\u003e This study was approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University and obtained informed consent from the patients. From August 2024 to November 2024, three patients with a primary diagnosis of advanced heart failure underwent minimally invasive left ventricular assist device (LVAD) implantation treatment in the cardiovascular surgery department of Zhongnan Hospital of Wuhan University, with clinical data sourced from case records.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.2 Operative technique\\u003c/h2\\u003e\\u003cp\\u003eOur cardiac team, comprising experts from the Advanced Heart Failure Unit within the Department of Cardiovascular Surgery at Zhongnan Hospital of Wuhan University, in collaboration with cardiac surgeons, anesthesiologists, and ultrasound specialists, jointly diagnosed patients with end-stage refractory heart failure. Following the criteria for left ventricular assist device (LVAD) implantation[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]: ①patients with end-stage severe heart failure meeting heart transplantation criteria, NYHA class IV, who continue to experience progressive symptoms despite guideline-directed standard treatment for stage D heart failure[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e];②those who are heavily dependent on positive inotropic agents, have received maximum doses of vasoactive drug therapy, and are severely reliant on intra-aortic balloon pump (IABP), circulatory support pump catheters, and external LVAD[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]༛③patients without severe right heart failure and significant tricuspid regurgitation;④those with progressive renal and/or liver function deterioration due to decreased perfusion rather than inadequate left ventricular filling pressure (pulmonary capillary wedge pressure\\u0026thinsp;\\u0026ge;\\u0026thinsp;20 mmHg, and systolic blood pressure\\u0026thinsp;\\u0026le;\\u0026thinsp;80\\u0026ndash;90 mmHg or cardiac index\\u0026thinsp;\\u0026le;\\u0026thinsp;2 L\\u0026bull;min-1\\u0026bull;m-2).\\u003c/p\\u003e\\u003cp\\u003eThe patient was placed in a supine position under general anesthesia, with a single-lumen tracheal intubation. Intraoperative transesophageal echocardiography (TEE) indicated left atrial enlargement, generalized reduction in left ventricular wall motion amplitude, decreased left ventricular systolic function, formation of an apical ventricular aneurysm, and preserved right ventricular wall motion amplitude. Moderate regurgitant signals were observed at the mitral valve orifice, while no significant regurgitant signals were noted at the aortic valve orifice. Incisions were made in the left fifth intercostal space (from the midclavicular line to the anterior axillary line), the right second intercostal space (from the sternum to the midclavicular line), and the right groin (obliquely) to open the skin and subcutaneous tissue, reaching the left and right thoracic cavities and the femoral artery and vein on the right side. A 5\\u0026thinsp;\\u0026minus;\\u0026thinsp;0 Prolene purse-string suture was placed on the right femoral artery and vein. The patient was systemically heparinized, and the position of the artificial heart pump was marked at the apex under esophageal ultrasound guidance. Cannulation of the right femoral artery and vein was performed for extracorporeal circulation, with a 3\\u0026thinsp;\\u0026minus;\\u0026thinsp;0 Prolene purse-string suture securing the infusion needle at the root. A cruciate incision was made at the abdominal access point, and a cable was guided through. After occlusion of the ascending aorta, the root infusion needle was used to infuse Del Nido solution to induce cardiac arrest. A 3\\u0026thinsp;\\u0026minus;\\u0026thinsp;0 Prolene suture with felt was used to intermittently secure the ventricular connector at the apex, followed by an apical incision to install the blood pump. The ascending aorta was opened for venting, and the heart resumed beating in a sinus rhythm. A side clamp was used to occlude part of the ascending aorta, and a 5\\u0026thinsp;\\u0026minus;\\u0026thinsp;0 Prolene suture was used to anastomose the artificial blood vessel to the root of the ascending aorta, with intermittent reinforcement of the anastomosis using 5\\u0026thinsp;\\u0026minus;\\u0026thinsp;0 Prolene and bovine pericardium. The blood pump was gradually started and vented. After venting the heart, the side clamp was released, and circulatory support was initiated, gradually transitioning to the artificial blood pump, set at 2600 rpm with a flow rate of 4.0 L/min, followed by adjustments for shutdown and removal of the extracorporeal cannula. Protamine was used to neutralize heparin, and vancomycin plus gentamicin were instilled into the pericardial cavity. Left and right chest tubes were placed, and routine closure of the chest was performed, followed by suturing of the subcutaneous tissue and skin. The procedure was smooth, and the patient was safely returned to the ICU after surgery.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.3 Postoperative management\\u003c/h2\\u003e\\u003cp\\u003ePostoperatively, the patient was transferred to the Intensive Care Unit (ICU) for continued treatment and early extubation. The treatment included anti-infection therapy, management of left and right heart balance, positive inotropic support, diuretics, nutritional support, maintenance of organ function, and symptomatic support.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.4 Statistical analysis\\u003c/h2\\u003e\\u003cp\\u003eClinical data, ultrasound data, hemodynamic data, perioperative data, and surgical data from before and after the surgery were organized and analyzed using SPSS 26.0. Considering the sample size and the non-normal distribution of the data, the results are presented as medians and interquartile ranges.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"3. RESULTS\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.1 Patient characteristics\\u003c/h2\\u003e\\u003cp\\u003eThe preoperative clinical data of the patients are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Between August 2024 and November 2024, a total of three patients underwent minimally invasive left ventricular assist device (LVAD) implantation. The median age of the cohort was 55.33 years[interquartile range (IQR): 36.00\\u0026ndash;74.00 years], and all patients were male. The median body mass index (BMI) was 26.90[IQR: 24.70\\u0026ndash;30.30]. All patients were diagnosed with ischemic cardiomyopathy. Of these, 33.33% (1/3) had hypertension, 66.67% (2/3) had coronary artery disease, and all patients (100%) were classified as New York Heart Association (NYHA) class IV. Additionally, 33.33% (1/3) had aortic disease, 33.33% (1/3) had an INTERMACS score of 1, and 66.67% (2/3) had an INTERMACS score of 3. Furthermore, 33.33% (1/3) of the patients were concurrently using intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) prior to surgery, all patients (100%, 3/3) were on positive inotropic agents, and all (100%, 3/3) exhibited valvular regurgitation.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePatient's characteristics\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eClinical data\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCase 1\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eCase 2\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCase 3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGender\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3(Male)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge(years)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e74.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e56.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e36.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e55.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;19.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBMI(kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e25.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e30.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.99\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHypertension\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e33.33%(1/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDiabetes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0%(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHyperlipidemia\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0%(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCoronary heart disease\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e66.67%(2/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNYHA\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eⅣ\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eⅣ\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eⅣ\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e100%(3/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAortic disease\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e33.33%(1/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePeripheral vascular disease\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0%(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCerebrovascular disease\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0%(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRenal Diseases\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0%(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDigestive System Diseases\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e66.67%(2/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePositive inotropic drug\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e100%(3/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eICD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0%(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIABP\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e66.67%(2/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eECMO\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e33.33%(1/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eINTERMACS\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSmoking history\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e66.67%(2/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSevere\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSevere\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eModerate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e100%(3/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e100%(3/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMild-Moderate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e100%(3/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePulmonary hypertension\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e33.33%(1/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eY: Patients have this disease N༚Patients don\\u0026rsquo;t have this disease\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.2 Preoperative and Postoperative hemodynamics\\u003c/h2\\u003e\\u003cp\\u003eTables\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e display the hemodynamic and echocardiographic results before and after surgery. The preoperative median values were as follows: mean arterial pressure (MAP) at 83.33 mmHg [interquartile range (IQR): 76.00\\u0026ndash;95.00 mmHg], central venous pressure (CVP) at 14.66 mmHg [IQR: 9.00\\u0026ndash;24.00 mmHg], systolic pulmonary artery pressure (sPAP) at 42.66 mmHg [IQR: 29.00\\u0026ndash;50.00 mmHg], mean pulmonary artery pressure (mPAP) at 20.67 mmHg [IQR: 19.00\\u0026ndash;22.00 mmHg], pulmonary capillary wedge pressure (PCWP) at 18.66 mmHg [IQR: 12.00\\u0026ndash;27.00 mmHg], arterial oxygen saturation (SaO2) at 99.20% [IQR: 97.60\\u0026ndash;100.00%], mixed venous oxygen saturation (SvO2) at 57.53% [IQR: 50.00-72.60%], cardiac index (CI) at 3.33 L/min/m\\u0026sup2; [IQR: 2.60\\u0026ndash;3.90 L/min/m\\u0026sup2;], and cardiac output (CO) at 6.00 L/min [IQR: 5.00-6.70 L/min]. Postoperatively, the median values were as follows: MAP at 81.66 mmHg [IQR: 69.00\\u0026ndash;94.00 mmHg], CVP at 8.33 mmHg [IQR: 6.00\\u0026ndash;11.00 mmHg], sPAP at 34.33 mmHg [IQR: 30.00\\u0026ndash;39.00 mmHg], mPAP at 19.00 mmHg [IQR: 15.00\\u0026ndash;22.00 mmHg], PCWP at 25.00 mmHg [IQR: 22.00\\u0026ndash;28.00 mmHg], SaO2 at 99.67% [IQR: 99.00-100.00%], SvO2 at 51.66% [IQR: 49.00\\u0026ndash;54.00%], CI at 3.40 L/min/m\\u0026sup2; [IQR: 3.20\\u0026ndash;3.60 L/min/m\\u0026sup2;], and CO at 5.63 L/min [IQR: 5.10-6.00 L/min]. The echocardiographic assessment revealed that the median ejection fraction (EF) percentage of patients prior to surgery was 30.33% [interquartile range: 25.00\\u0026ndash;37.00%], while the median fractional shortening (FS) percentage was 14% [interquartile range: 11\\u0026ndash;18%]. The median left ventricular (LV) dimension was 5.97 mm [interquartile range: 5.50\\u0026ndash;6.70 mm], and the median right ventricular (RV) dimension was 4.36 mm [interquartile range: 3.70\\u0026ndash;4.90 mm]. All patients (100%, 3/3) demonstrated varying degrees of valvular regurgitation. Following surgical intervention, the median EF percentage increased to 42.33% [interquartile range: 36.00\\u0026ndash;46.00%], and the median FS percentage improved to 20.33% [interquartile range: 18.00\\u0026ndash;23.00%]. The median LV dimension decreased to 5.40 mm [interquartile range: 4.80\\u0026ndash;6.20 mm], and the median RV dimension reduced to 3.77 mm [interquartile range: 3.50-4.00 mm]. Notably, all patients (100%, 3/3) exhibited resolution of valvular regurgitation postoperatively.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePatient's Pre- and Post-operative hemodynamic parameters\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"9\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c5\\\" 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3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMAP(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e76.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e79.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e95.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e83.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e69.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e94.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e82.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e81.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCVP(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e11.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e14.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e8.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e11.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e6.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e8.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003esPAP(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e29.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e49.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e50.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e42.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.84\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e30.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e39.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e34.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e34.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.51\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003emPAP(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e19.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e21.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e22.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e20.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.53\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e20.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e22.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e15.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e19.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePCWP(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e17.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e27.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e18.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.64\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e25.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e22.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e28.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e25.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSaO\\u003csub\\u003e2\\u003c/sub\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e97.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e100.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e100.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e99.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e99.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e100.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e100.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e99.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.58\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSvO\\u003csub\\u003e2\\u003c/sub\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e50.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e72.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e50.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e57.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e49.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e54.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" 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colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLV(cm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.64\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e5.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e4.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e6.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.07\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRA(cm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e4.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e4.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e3.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e3.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRV(cm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4.90\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e11.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e14.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e23.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e20.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e18.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e20.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMVE(m/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.13\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAV(m/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePV(m/s)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePA(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2.43\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e2.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e2.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e2.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSevere\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSevere\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eModerate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMild\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMild-Moderate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eY: Patients have this disease N༚Patients don\\u0026rsquo;t have this disease\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.3 Operation and clinical results\\u003c/h2\\u003e\\u003cp\\u003eThe surgical and postoperative complications are comprehensively presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e. One patient underwent closure of a patent foramen ovale in conjunction with ECMO weaning and the implementation of an intra-aortic balloon pump, whereas another patient underwent closure of a patent foramen ovale combined with left atrial appendage occlusion. The median surgical duration was 311.67 minutes [IQR: 240.00-380.00min]. The median intraoperative blood loss was 533.33 ml [IQR: 500.00-600.00ml], and the median duration of cardiopulmonary bypass was 169.00 minutes [IQR: 121.00-214.00min]. Postoperatively, the median duration of mechanical ventilation was 3.00 days [IQR: 1.00-5.00days], and the median length of stay in the ICU was 5.00 days [IQR: 3.00-7.00days]. Perioperative complications included arrhythmias in 33% of patients (1/3), with no occurrences of thrombus formation, re-thoracotomy, or gastrointestinal bleeding (0 /3). The 30-day mortality rate was 0% (0/3), and the six-month survival rate was 100% (3/3).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePatient's intraoperative and postoperative parameters\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCase 1\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eCase 2\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCase 3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLVAD Type\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCorheart\\u0026reg;\\u0026nbsp;6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eCorheart\\u0026reg;\\u0026nbsp;6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCH-VAD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOperation Time(min)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e240.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e315.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e380.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e311.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;70.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCardiopulmonary Bypass Time(min)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e121.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e172.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e214.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e169.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;46.57\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAortic Occlusion Time(min)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e49.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e64.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e111.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e74.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;32.35\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIntraoperative Blood Loss(ml)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e600.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e500.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e500.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e533.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;57.74\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eICU Time(days)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDuration of Mechanical Ventilation (Days)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePostoperative Complications\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDeath\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eArrhythmia\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eY\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1(1/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSecondary Thoracotomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGastrointestinal Bleeding\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eThrombosis\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0(0/3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eY: Patients have this disease N༚Patients don\\u0026rsquo;t have this disease\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"4. DISCUSSION\",\"content\":\"\\u003cp\\u003eThe conventional implantation of a left ventricular assist device (LVAD) is typically conducted via a median sternotomy accompanied by cardiac arrest, representing the standard surgical method in contemporary practice. This method provides excellent surgical exposure for the implanted pump, maintains complete coverage of the heart during the procedure, reduces adhesion to surrounding tissues, ensures hemodynamic stability, allows for thorough examination of the left heart structures, facilitates venting, and can correct intracardiac abnormalities simultaneously. However, it is undeniable that this technique is highly invasive, associated with significant intraoperative bleeding, a high risk of infection, and prolonged hospital stays for patients. Additionally, it carries risks such as blood dilution, coagulation dysfunction, systemic inflammatory response, increased pulmonary artery pressure, and right heart failure[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eWith the development of minimally invasive cardiac surgery and the miniaturization of third-generation LVAD pumps, minimally invasive LVAD implantation techniques have become a trend in clinical practice and a pressing need for patients[\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR17 CR18 CR19\\\" citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. In three instances of minimally invasive left ventricular assist device (LVAD) implantation successfully conducted at our center, metrics including surgical duration, anesthesia duration, extracorporeal circulation time, blood loss, length of ICU stay, and duration of mechanical ventilation were all significantly shortened or improved compared to traditional open-heart surgery.\\u003c/p\\u003e\\u003cp\\u003eDuring the surgical procedure, We found that compared to conventional open-heart surgery[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], minimally invasive LVAD implantation not only preserves the integrity of the sternum and allows for the LVAD pump to be implanted through a small incision[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e], thereby minimizing surgical trauma, but also effectively avoids myocardial ischemia-reperfusion injury, reduces intraoperative blood loss and the use of blood products [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]and shortens the duration of positive inotropic drug use[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e], while decreasing the risk of wound infection[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. Additionally, after the surgery, we also found that the patient's sternum remained intact, with only a 2-centimeter incision under the left rib. It preserves more anatomical options for future heart transplantation or other cardiac surgeries. Postoperatively, patients recover well and can mobilize early[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e], shortening the recovery period and hospital stay[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eFurthermore, it is learned that the implantation of the LVAD pump provides stable hemodynamic support to maintain the function of terminal organs[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]and can also be used for support therapy prior to cardiac function recovery, transitional support therapy while waiting for heart transplantation[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]and permanent assistive treatment for patients who are not suitable candidates for heart transplantation[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].The minimally invasive implantation of LVAD can be conducted while the heart remains beating[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e], a technique that significantly mitigates cardiac damage, reduces perioperative complications, and enhances long-term outcomes. Moreover, maintaining cardiac activity ensures adequate filling of the left ventricle. Additionally, we use a left intercostal incision can enhance apical suspension, thereby facilitating more effective gas evacuation and reducing the risk of gas embolism during the perioperative period.\\u003c/p\\u003e\\u003cp\\u003eImportantly, we think that one of the most challenging issues associated with LVAD implantation is the postoperative balance between the left and right heart[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e], This includes problems such as changes in preload and afterload, increased right ventricular pressure, fluid imbalance, hemodynamic monitoring, and uneven mechanical loading[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eHowever, minimally invasive LVAD implantation can reduce the risk of right heart failure during the perioperative period[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR31\\\" citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e], mainly for the following reasons: (1) Minimally invasive surgical techniques use smaller incisions, reducing mechanical damage to the thoracic cavity and heart, which helps protect right heart function. (2) During the surgery, intraoperative ultrasound and observation of hemodynamic parameters allow for timely assessment of cardiac function, enabling adjustments to LVAD parameters to optimize blood flow balance between the left and right heart[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].(3) Based on the specific cardiac function status of the patient, the speed of the LVAD can be adjusted to ensure that blood flow meets the body\\u0026rsquo;s needs, thereby reducing the burden on the right heart. (4) Minimally invasive techniques decrease the incidence of perioperative complications[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e], lowering the risk of postoperative right heart failure and thus facilitating the balance of cardiac function[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e].(5) Postoperatively, closely monitoring and managing the patient's fluid status, medication use, and cardiac function evaluation helps maintain overall cardiac balance. (6) Patients typically recover quickly after minimally invasive surgery, but attention must still be paid to the burden on the right heart, optimizing fluid intake, medication, and rehabilitation plans to maintain overall cardiac function. Minimally invasive LVAD implantation surgery effectively enhances the likelihood of achieving balance between the left and right heart by reducing trauma and complications, combined with personalized management approaches[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e].This represents a significant advancement in the field of cardiac surgery in recent years.\\u003c/p\\u003e\\u003cp\\u003eMinimally invasive LVAD implantation can also improve early survival rates for patients[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e], particularly for critically ill patients with advanced heart failure[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e], we had completed three cases: the elderly and those with high body weight[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e], as well as patients on IABP\\u0026thinsp;+\\u0026thinsp;ECMO[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].This procedure effectively reduces perioperative complications for these patients, including the risks of postoperative infection, bleeding, and other complications[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].Due to the smaller incision, patients typically recover faster and return to their daily lives more quickly, which helps improve postoperative survival rates. Minimally invasive LVAD surgery can support cardiac function earlier, reduce the burden of heart failure, and rapidly improve the patient's hemodynamic status, promoting the recovery of multiple organ functions. Real-time monitoring of hemodynamic changes during the procedure aids in timely adjustments to LVAD parameters, providing stable blood flow, reducing cardiac load, and preventing the worsening of heart failure. In minimally invasive surgeries, doctors can develop more personalized surgical and postoperative management plans based on the specific conditions of the patient, optimizing efficacy and minimizing risks. The advantages of minimally invasive surgery include shorter hospital admission and stay times, which contribute to the recovery of mental health, while also alleviating the economic burden and psychological stress on patients and their families, thereby enhancing the overall survival capacity of patients. Therefore, minimally invasive LVAD implantation offers a safer and more effective treatment option for critically ill patients with advanced heart failure, significantly improving early survival rates[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eHowever, consistent with the results reported by most centers, there is no significant difference in mid- to long-term survival rates between minimally invasive and median sternotomy approaches[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e],The purpose of this article is to analyze the technical advantages and clinical experience of minimally invasive LVAD implantation. With the development of minimally invasive cardiac surgery and the improvement and updating of LVAD pumps, minimally invasive LVAD implantation techniques are gradually becoming a trend in clinical practice and a practical need for patients[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].Compared to traditional open-heart surgery, the learning curve for minimally invasive LVAD implantation techniques is long and the learning difficulty is high [\\u003cspan additionalcitationids=\\\"CR40\\\" citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e], This approach requires a well-coordinated team and highly specialized skills[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e], and it emphasizes the importance of preoperative technical planning as well as postoperative care and monitoring. As long as the team is experienced, the skills are proficient, there is sufficient multidisciplinary discussion before the operation, tight monitoring during the procedure to reduce risks, and enhanced care after surgery, minimally invasive LVAD implantation remains a safe, effective, and feasible method for treating advanced heart failure[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e].\\u003c/p\\u003e\"},{\"header\":\"5. CONCLUSIONS\",\"content\":\"\\u003cp\\u003eThe implantation of a minimally invasive LVAD for patients with advanced heart failure is a safe and effective surgical method that can improve symptoms, reduce complications, lower the risk of perioperative right heart failure, and enhance early survival rates.\\u003c/p\\u003e\"},{\"header\":\"6. LIMITATIONS\",\"content\":\"\\u003cp\\u003eThe limitations of this study include a small number of cases, a short follow-up period, and the lack of comparative analysis between patients undergoing open chest and minimally invasive surgery.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eACKNOWLEDGMENTS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research was supported by the National Natural Science Foundation of China (No. 82470421). We declare that this manuscript has not been published elsewhere, in whole or in part, and has not been presented at any scientific meeting, including in abstract form.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAUTHOR CONTRIBUTIONS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e(I) Conception and design: Chen Xing and Liu Jinping;(II) Administrative support: Liu Jinping;(III) Provision of study materials or patients: Cai Jie and Yu Wenjun;(IV) Collection and assembly of data: Wang Qingpeng and Wang Wei;(V) Data analysis and interpretation: Wang Qingpeng;(VI) All authors contributed to the manuscript writing and final approval of manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONFLICT OF INTEREST STATEMENT\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that there are no conflicts of interest regarding the publication of this article, including among co-authors. All authors have agreed to publish this article in \\u003cem\\u003ethe\\u003c/em\\u003e\\u003cem\\u003eJournal of Cardiothoracic Surgery\\u003c/em\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDATA AVAILABILITY STATEMENT\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eOno M, Yamaguchi O, Ohtani T, Kinugawa K, Saiki Y, Sawa Y, Shiose A, Tsutsui H, Fukushima N, Matsumiya G, et al. JCS/JSCVS/JATS/JSVS 2021 Guideline on Implantable Left Ventricular Assist Device for Patients With Advanced Heart Failure. Circ J. 2022;86(6):1024\\u0026ndash;58.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMorris AA, Khazanie P, Drazner MH, Albert NM, Breathett K, Cooper LB, Eisen HJ, O'Gara P, Russell SD. Guidance for Timely and Appropriate Referral of Patients With Advanced Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2021;144(15):e238\\u0026ndash;50.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChatterjee A, Mariani S, Hanke JS, Li T, Merzah AS, Wendl R, Haverich A, Schmitto JD, Dogan G. Minimally invasive left ventricular assist device implantation: optimizing device design for this approach. Expert Rev Med Devices. 2020;17(4):323\\u0026ndash;30.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRicklefs M, Hanke JS, Dogan G, Napp LC, Feldmann C, Haverich A, Schmitto JD. Less Invasive Surgical Approaches for Left Ventricular Assist Device Implantation. Semin Thorac Cardiovasc Surg. 2018;30(1):1\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHanke JS, Rojas SV, Avsar M, Haverich A, Schmitto JD. Minimally-invasive LVAD Implantation: State of the Art. Curr Cardiol Rev. 2015;11(3):246\\u0026ndash;51.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRojas SV, Avsar M, Hanke JS, Khalpey Z, Maltais S, Haverich A, Schmitto JD. Minimally invasive ventricular assist device surgery. Artif Organs. 2015;39(6):473\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePotapov E, Loforte A, Pappalardo F, Morshuis M, Schibilsky D, Zimpfer D, Lewin D, Riebandt J, Von Aspern K, Stein J, et al. Impact of a surgical approach for implantation of durable left ventricular assist devices in patients on extracorporeal life support. J Card Surg. 2021;36(4):1344\\u0026ndash;51.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRiebandt J, Schl\\u0026ouml;glhofer T, Moayedifar R, Wiedemann D, Wittmann F, Angleitner P, Dimitrov K, Tschernko E, Laufer G, Zimpfer D. Less Invasive Left Ventricular Assist Device Implantation Is Safe and Reduces Intraoperative Blood Product Use: A Propensity Score Analysis VAD Implantation Techniques and Blood Product Use. ASAIO J. 2021;67(1):47\\u0026ndash;52.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePasrija C, Sawan MA, Sorensen E, Voorhees H, Shah A, Strauss E, Ton V-K, DiChiacchio L, Kaczorowski DJ, Griffith BP, et al. Less invasive left ventricular assist device implantation may reduce right ventricular failure. Interact Cardiovasc Thorac Surg. 2019;29(4):592\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMonteagudo Vela M, Rial Bast\\u0026oacute;n V, Panoulas V, Riesgo Gil F, Simon A. A detailed explantation assessment protocol for patients with left ventricular assist devices with myocardial recovery. Interact Cardiovasc Thorac Surg. 2021;32(2):298\\u0026ndash;305.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRabin J, Ziegler LA, Cipriano S, Madathil RJ, Feller ED, Sorensen EN, Griffith BP, Kaczorowski DJ. Minimally Invasive Left Ventricular Assist Device Insertion Facilitates Subsequent Heart Transplant. Innovations (Phila). 2021;16(2):157\\u0026ndash;62.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eZiegler LA, Bittle GJ, Klass WJ, Sorensen EN, Madathil RJ, Feller ED, Griffith BP, Kaczorowski DJ. A Minimally Invasive Approach to Left Ventricular Assist Device Insertion Facilitates Subsequent Explant. Innovations (Phila). 2021;16(1):104\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCorrection to. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;147(14):e674.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSabashnikov A, Popov A-F, Bowles CT, Mohite PN, Weymann A, Hards R, Hedger M, Wittwer T, Wippermann J, Wahlers T et al. Outcomes after implantation of partial-support left ventricular assist devices in inotropic-dependent patients: Do we still need full-support assist devices? J Thorac Cardiovasc Surg 2014, 148(3).\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLampert BC, Teuteberg JJ, Cowger J, Mokadam NA, Cantor RS, Benza RL, Ganapathi AM, Myers SL, Hiesinger W, Woo J, et al. Impact of thoracotomy approach on right ventricular failure and length of stay in left ventricular assist device implants: an intermacs registry analysis. J Heart Lung Transpl. 2021;40(9):981\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAl-Naamani A, Fahr F, Khan A, Bireta C, Nozdrzykowski M, Feder S, Deshmukh N, Jubeh M, Eifert S, Jawad K, et al. Minimally invasive ventricular assist device implantation. J Thorac Dis. 2021;13(3):2010\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWiedemann D, Haberl T, Angleitner P, Dimitrov K, Laufer G, Zimpfer D. Minimally invasive approaches for implantation of left ventricular assist devices. Indian J Thorac Cardiovasc Surg. 2018;34(Suppl 2):177\\u0026ndash;82.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWachter K, Franke UFW, Rustenbach CJ, Baumbach H. Minimally Invasive versus Conventional LVAD-Implantation-An Analysis of the Literature. Thorac Cardiovasc Surg. 2019;67(3):156\\u0026ndash;63.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMakdisi G, Wang IW. Minimally invasive is the future of left ventricular assist device implantation. J Thorac Dis. 2015;7(9):E283\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMolina EJ, Boyce SW. Current status of left ventricular assist device technology. Semin Thorac Cardiovasc Surg. 2013;25(1):56\\u0026ndash;63.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGerhard EF, Wang L, Singh R, Schueler S, Genovese LD, Woods A, Tang D, Smith NR, Psotka MA, Tovey S, et al. LVAD decommissioning for myocardial recovery: Long-term ventricular remodeling and adverse events. J Heart Lung Transpl. 2021;40(12):1560\\u0026ndash;70.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRibeiro RVP, Lee J, Elbatarny M, Friedrich JO, Singh S, Yau T, Yanagawa B. Left ventricular assist device implantation via lateral thoracotomy: A systematic review and meta-analysis. J Heart Lung Transpl. 2022;41(10):1440\\u0026ndash;58.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAyers BC, Bjelic M, Wood K, Sheen S, Morrison E, Prasad S, Gosev I. Complete sternal-sparing left ventricular assist device implantation is associated with improved postoperative mobility. Interact Cardiovasc Thorac Surg. 2021;32(6):878\\u0026ndash;81.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eZaky M, Nordan T, Kapur NK, Vest AR, DeNofrio D, Chen FY, Couper GS, Kawabori M. Impella 5.5 Support Beyond 50 Days as Bridge to Heart Transplant in End-Stage Heart Failure Patients. ASAIO J. 2023;69(4):e158\\u0026ndash;62.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSchaefer A, Reichart D, Bernhardt AM, Kubik M, Barten MJ, Wagner FM, Reichenspurner H, Philipp SA, Deuse T. Outcomes of Minimally Invasive Temporary Right Ventricular Assist Device Support for Acute Right Ventricular Failure During Minimally Invasive Left Ventricular Assist Device Implantation. ASAIO J. 2017;63(5):546\\u0026ndash;50.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSaeed D, Muslem R, Rasheed M, Caliskan K, Kalampokas N, Sipahi F, Lichtenberg A, Jawad K, Borger M, Huhn S, et al. Less invasive surgical implant strategy and right heart failure after LVAD implantation. J Heart Lung Transpl. 2021;40(4):289\\u0026ndash;97.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCheung A, Bashir J, Kaan A, Kealy J, Moss R, Shayan H. Minimally invasive, off-pump explant of a continuous-flow left ventricular assist device. J Heart Lung Transpl. 2010;29(7):808\\u0026ndash;10.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLewin D, Rojas SV, Billion M, Meyer AL, Netuka I, Kooij J, Pieri M, Loforte A, Szymanski MK, Moeller CH, et al. Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life support. JTCVS Open. 2024;21:168\\u0026ndash;79.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eL\\u0026oslash;gstrup BB, Nemec P, Schoenrath F, Gummert J, Pya Y, Potapov E, Netuka I, Ramjankhan F, Parner ET, De By T, et al. Heart failure etiology and risk of right heart failure in adult left ventricular assist device support: the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). Scand Cardiovasc J. 2020;54(5):306\\u0026ndash;14.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAdamopoulos S, Bonios M, Ben Gal T, Gustafsson F, Abdelhamid M, Adamo M, Bayes-Genis A, B\\u0026ouml;hm M, Chioncel O, Cohen-Solal A et al. Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCarmona A, Hoang Minh T, Perrier S, Schneider C, Marguerite S, Ajob G, Mircea C, Mertes P-M, Ramlugun D, Atlan J, et al. Minimally invasive surgery for left ventricular assist device implantation is safe and associated with a decreased risk of right ventricular failure. J Thorac Dis. 2020;12(4):1496\\u0026ndash;506.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMohite PN, Sabashnikov A, Raj B, Hards R, Edwards G, Garc\\u0026iacute;a-S\\u0026aacute;ez D, Zych B, Husain M, Jothidasan A, Fatullayev J, et al. Minimally Invasive Left Ventricular Assist Device Implantation: A Comparative Study. Artif Organs. 2018;42(12):1125\\u0026ndash;31.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eReichart D, Brand CF, Bernhardt AM, Schmidt S, Schaefer A, Blankenberg S, Reichenspurner H, Wagner FM, Deuse T, Barten MJ. Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation - A Single-Center Experience. Thorac Cardiovasc Surg. 2019;67(3):170\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWert L, Chatterjee A, Dogan G, Hanke JS, Boethig D, T\\u0026uuml;mler KA, Napp LC, Berliner D, Feldmann C, Kuehn C, et al. Minimally invasive surgery improves outcome of left ventricular assist device surgery in cardiogenic shock. J Thorac Dis. 2018;10(Suppl 15):S1696\\u0026ndash;702.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePasrija C, Sawan MA, Sorensen E, Voorhees HJ, Shah A, Wang L, Ton V-K, DiChiacchio L, Kaczorowski DJ, Griffith BP, et al. Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients. Innovations (Phila). 2020;15(3):243\\u0026ndash;50.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBjelic M, Ayers B, Paic F, Bernstein W, Barrus B, Chase K, Gu Y, Alexis JD, Vidula H, Cheyne C, et al. Study results suggest less invasive HeartMate 3 implantation is a safe and effective approach for obese patients. J Heart Lung Transpl. 2021;40(9):990\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eJeng EI, Miller AH, Friedman J, Tapia-Ruano SA, Reilly K, Parker A, Vilaro J, Aranda JM, Klodell CT, Beaver TM, et al. Ventricular Assist Device Implantation and Bariatric Surgery: A Route to Transplantation in Morbidly Obese Patients with End-Stage Heart Failure. ASAIO J. 2021;67(2):163\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSchmitto JD, Rojas SV, Hanke JS, Avsar M, Haverich A. Minimally invasive left ventricular assist device explantation after cardiac recovery: surgical technical considerations. Artif Organs. 2014;38(6):507\\u0026ndash;10.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003e\\u0026Ouml;zer T, Gunay D, Hancer H, Altas Yerlikhan O, Ozgur MM, Aksut M, Sarikaya S, Kirali K. Transition from Conventional Technique to Less Invasive Approach in Left Ventricular Assist Device Implantations. ASAIO J. 2020;66(9):1000\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRobinson D, Fitzsimmons M, Waters K, Mohiuddin F, Knight P, Sauer J Jr, Gosev CJ. A novel model for minimally invasive left ventricular assist device implantation training. Minim Invasive Ther Allied Technol. 2020;29(4):194\\u0026ndash;201.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eZhang L-F, Feng H-B, Yu Z-G, Jing S, Wan F. Surgical Training Improves Performance in Minimally Invasive Left Ventricular Assist Device Implantation Without Cardiopulmonary Bypass. J Surg Educ. 2018;75(1):195\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCheung A, Soon J-L, Bashir J, Kaan A, Ignaszewski A. Minimal-access left ventricular assist device implantation. Innovations (Phila). 2014;9(4):281\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-cardiothoracic-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jcts\",\"sideBox\":\"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)\",\"snPcode\":\"13019\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13019/3\",\"title\":\"Journal of Cardiothoracic Surgery\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Minimally Invasive, LAVD, Retrospective Study\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6721233/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6721233/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjective\\u003c/h2\\u003e\\u003cp\\u003eThis retrospective analysis reveals the clinical experience and technical advantages of minimally invasive left ventricular assist device (LVAD) implantation for patients with advanced heart failure. It highlights our single-center experience and discusses the potential of minimally invasive LVAD implantation, offering promising insights.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eOur team evaluated patients who met the criteria for LVAD implantation surgery. We performed minimally invasive LVAD implantation for these patients and compared their cardiac function, intraoperative conditions, hemodynamics, and perioperative complications before and after the surgery. We used SPSS 26.0 software to statistically analyze the technical advantages of minimally invasive LVAD implantation.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eWithin three months, a total of three patients underwent minimally invasive LVAD implantation surgery, all of whom were male, with a median age of 55.33 years [IQR:36.00\\u0026ndash;74.00 years]. The median body mass index was 26.90 [IQR:24.70\\u0026ndash;30.30]. All three patients (100%) were diagnosed with ischemic cardiomyopathy. Among them, 33.33% (1/3) had hypertension, 66.67% (2/3) had coronary artery disease, and 100% (3/3) were classified as NYHA class IV. Additionally, 33.33% (1/3) had aortic disease, 33.33% (1/3) had an INTERMACS score of 1, and 66.67% (2/3) had an INTERMACS score of 3. Preoperatively, 33.33% (1/3) of the patients were on both IABP and ECMO, while 100% (3/3) received positive inotropic agents, and all patients (3/3) had valve regurgitation. The median surgical time was 311.67 minutes [IQR:240.00-380.00 minutes], with a median intraoperative blood loss of 533.33 ml [IQR:500\\u0026ndash;600 ml] and a median cardiopulmonary bypass time of 169.00 minutes [IQR:121.00-214.00 minutes]. Postoperatively, the median duration of mechanical ventilation was 3.00 days [IQR:1.00\\u0026ndash;5.00 days], and the median ICU stay was 5.00 days [IQR:3.00\\u0026ndash;7.00 days]. Perioperative complications included arrhythmias in 33% (1/3), thrombosis in 0% (0/3), re-thoracotomy in 0% (0/3), and gastrointestinal bleeding in 0% (0/3). The 30-day mortality rate was 0% (0/3), while the six-month survival rate was 100% (3/3).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eThe implantation of a minimally invasive LVAD for the treatment of advanced heart failure is a safe and effective surgical method that can improve symptoms, reduce complications, lower the risk of perioperative right heart failure, and enhance early survival rates.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Minimally Invasive LVAD Implantation for Advanced Heart Failure: A Single-Center Retrospective Analysis and the Promise of Minimally Invasive Approaches\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-17 16:21:01\",\"doi\":\"10.21203/rs.3.rs-6721233/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-09-25T17:47:36+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-07-29T13:46:31+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-07-26T18:26:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-07-20T05:55:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"314423575556236490958889137085178741370\",\"date\":\"2025-07-16T04:00:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"76573073386485783527904637663307914966\",\"date\":\"2025-07-16T02:09:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"75138429070190445888395470668825407695\",\"date\":\"2025-07-15T15:44:25+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-07-15T10:44:06+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-05-23T03:17:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-05-23T03:16:35+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Journal of Cardiothoracic Surgery\",\"date\":\"2025-05-22T04:59:11+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-cardiothoracic-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jcts\",\"sideBox\":\"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)\",\"snPcode\":\"13019\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13019/3\",\"title\":\"Journal of Cardiothoracic Surgery\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"5e66f33e-44e2-469a-b56a-7dcffe4448bd\",\"owner\":[],\"postedDate\":\"July 17th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-01-05T16:04:08+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-6721233\",\"link\":\"https://doi.org/10.1186/s13019-025-03815-x\",\"journal\":{\"identity\":\"journal-of-cardiothoracic-surgery\",\"isVorOnly\":false,\"title\":\"Journal of Cardiothoracic Surgery\"},\"publishedOn\":\"2025-12-29 15:57:27\",\"publishedOnDateReadable\":\"December 29th, 2025\"},\"versionCreatedAt\":\"2025-07-17 16:21:01\",\"video\":\"\",\"vorDoi\":\"10.1186/s13019-025-03815-x\",\"vorDoiUrl\":\"https://doi.org/10.1186/s13019-025-03815-x\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6721233\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6721233\",\"identity\":\"rs-6721233\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}