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We reviewed all consecutive patients implanted with a continuous flow LVAD at our Institute. To exclude the possible bias related to the device used, out of 91 collected LVADs implants, we selected only those patients (<jats:italic>n<\/jats:italic>\u00a0=\u00a042) who received, between 2012 and 2015, the HeartWare HVAD. The analysis focused on the surgical approach used for the LVAD implant. Most of the patients (95%) were affected by dilated or ischemic cardiomyopathy, with an INTERMACS class I\u2010II in the majority of cases (77%). The LVAD implant was performed through a full sternotomy in 10 patients (24%); the remaining 32 cases (76%) were managed with minimally invasive procedures. These were left mini\u2010thoracotomy with upper mini\u2010sternotomy (20 patients, 62%), right and left mini\u2010thoracotomy (7 patients, 22%), and a recently developed left mini\u2010thoracotomy with outflow graft anastomosis to the left axillary artery (5 patients, 16%). The most common adverse event on device was right heart failure (26%). Eighteen patients (43%) were transplanted. Overall estimated 24 months survival (on device or after transplant) was 68\u00a0\u00b1\u00a07%. The causal analysis, adjusted by propensity score weighting baseline data and sample size, showed that left mini\u2010thoracotomy with outflow anastomosis to the left axillary artery resulted in a significantly reduced rate of post implant right heart failure (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01), and mechanical ventilation time (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.049). To conclude, in our series, by applying mini\u2010invasive implant techniques in the majority of cases, mid\u2010term survival of continuous flow LVADs in severely compromised patients was satisfactory. In the adjusted analysis, the left anterior mini\u2010thoracotomy with outflow anastomosis to the left axillary artery showed the most favorable results.<\/jats:p>","DOI":"10.1111\/aor.13339","type":"journal-article","created":{"date-parts":[[2018,7,31]],"date-time":"2018-07-31T05:58:21Z","timestamp":1533016701000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Minimally Invasive Implantation of Continuous Flow Left Ventricular Assist Devices: The Evolution of Surgical Techniques in a Single\u2010Center Experience"],"prefix":"10.1111","volume":"43","author":[{"given":"Massimiliano","family":"Carrozzini","sequence":"first","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonida","family":"Bejko","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvise","family":"Guariento","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Rubino","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Bianco","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Tarzia","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"Gregori","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomaso","family":"Bottio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gino","family":"Gerosa","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.07.005"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2016.01.002"},{"key":"e_1_2_8_4_1","first-page":"309","article-title":"The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio\u2010Thoracic Surgery (EACTS): second report","volume":"52","author":"By TMMH","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.058412"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2011.07.008"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2018.01.002"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu051"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0000000000000191"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5753"},{"key":"e_1_2_8_11_1","unstructured":"R Development Core Team.R: a language and evironment for statistical computing. n.d. 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