Left-Sided Implantation After Right-Sided Inspire Failure
Yes, the Inspire hypoglossal nerve stimulator can be successfully implanted on the left side if the right-sided device fails, and this has been demonstrated as both safe and effective in clinical practice.
Evidence for Contralateral Implantation
The feasibility of left-sided implantation is well-established through multiple technical approaches:
Primary left-sided implantation has been successfully performed using a 2-incision technique in case series, with no adverse events, device dysfunction, or cardiac artifact issues 1.
Contralateral rerouting from right to left has been documented, including successful placement of the respiratory sensing lead in the left second intercostal space and rerouting of the stimulation lead to a left-sided impulse generator 2.
The left-sided approach represents a significant technical modification of the original right-sided, 3-incision technique but maintains full device functionality 1.
Clinical Scenarios for Left-Sided Placement
Left-sided implantation may be indicated when:
- The right-sided device has failed mechanically or therapeutically
- Anatomical considerations on the right side preclude safe or effective implantation
- Surgical revision is required due to other medical conditions (e.g., breast cancer surgery necessitating device relocation) 2
- Patient-specific factors favor left-sided anatomy
Important Caveats
Patient selection criteria remain unchanged regardless of implantation side: moderate-to-severe OSA (AHI ≥15), BMI ≤35 kg/m², documented CPAP intolerance, and no contraindications must still be met 3.
BMI >35 kg/m² remains an absolute contraindication even for contralateral reimplantation, with bariatric surgery being the recommended primary intervention in this population 3.
The technical expertise required for left-sided implantation may be greater than standard right-sided placement, so ensure the surgical team has appropriate experience with device modifications 1, 2.