Minimally invasive is the future of left ventricular assist device implantation.

There have been many factors that have allowed for progressive improvement in outcomes and lower complication rates. These include the improvement in left ventricular assist device (LVAD) technologies, combined with better understanding of patient management, all these. Nowadays the numbers of LVAD implantations exceed the number of annual heart transplants worldwide. Minimally invasive procedures are shown to improve the surgical outcome in both LVAD insertion and replacement. These minimally invasive techniques can be grouped grossly into shifting from on-pump to off-pump implantation, alternative access for implantation other than sternotomy, and a combination of both, which should be the ultimate aim of minimally invasive LVAD implantation. Here we describe the alternative techniques and configurations of minimally invasive and sites of implantation.