Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia.

We describe the surgical technique and treatment of a 59-year-old male with cardiogenic shock, who underwent a minimally invasive off-pump ventricular assist device (VAD) implantation with the aid of paravertebral regional analgesia in bilateral mini-thoracotomies as first procedure described in the literature. He was extubated soon after the procedure, in the operating room, with the aim to reduce the right ventricle impairment. These issues are particularly true for patients suffering from pulmonary hypertension and disease, in whom the shortest time of postoperative intubation is fundamental to allow self-inotropic support and recovery of the right ventricle. We illustrate how a minimally invasive implant may improve the clinical outcomes of VAD patients shortening their return time to active life.