The field of left ventricular assist devices (LVADs) witnessed an important boost after the introduction of the third-generation durable mechanical circulatory support devices. Among the technical improvements which contributed to the success of these LVADs, the miniaturized pump body allowing for a complete intrapericardial implant is surely one of the most interesting. Indeed, the reduced dimensions and the compact design of centrifugal LVADs pushed surgeons to explore new surgical approaches for their implantation.¹ This brought to the development of less invasive techniques leading to reduced critical surgical complications² and increased numbers of patients eligible to receive LVAD implantation for heart failure. The core paradigm of less invasive LVAD surgery is the use of a left lateral thoracotomy (LT) to implant the pump body and avoid a full sternotomy. The first group to apply this technique was based at Hannover Medical School and performed the first LVAD implantation through LT (named LT-VAD) combining an upper hemisternotomy with a left anterolateral thoracotomy in 2011.³ After this early description of the LT-VAD technique, the interest toward this approach has steadily grown,^4–8 leading to the Conformité Européenne (CE) mark approval for less invasive implantation of a HeartWare centrifugal-flow ventricular assist device system (HVAD – Medtronic, Inc., Minneapolis, MN) in 2016. Further clinical studies such as the LATERAL Clinical Trial⁶ (ClinicalTrials.gov Identifier) followed in 2018 and led to the US Food and Drug Administration (US FDA) approval of less invasive HVAD implantation. In the same year, HeartMate3 (Abbott, Chicago, IL) was also implanted through lateral thoracotomy for the first time,⁹ demonstrating that LT-VAD can be safely applied to different devices.