Between February 2004 and December 2015, 87 exchanges of LVADs were performed at a single center. In 41 cases pump thrombosis was the reason for LVAD exchange. A total of 28 patient years (10,276 days) were analyzed. Average ICU stay was 15.8±20.4 days and average in-hospital stay 38.1±37.3 days after LVAD exchange. After thirty days the survival rate was 80.5%, 75.6% after 6 months and 70.7% one year after LVAD exchange. Out of the study cohort, three patients have successfully undergone heart transplantation. Twelve patients suffered a stroke postoperatively (29%). Twelve patients needed postoperative dialysis (29%). No technical complications of the VAD were recorded in the study group. Two patients underwent successful LVAD explantation due to myocardial recovery. One year after LVAD exchange, 14 patients underwent re-exchange due to pump thrombosis (34%). Eight patients suffered from a LVAD related infection out of which two patients were treated by pump exchange. A total of 12 patients died during the complete one year follow up of this study (29%). Four patients died in the second, two in the third and one in the fourth year after LVAD exchange. The remaining 17 patients are still ongoing on the device. It is generally feasible to treat pump thrombosis via LVAD exchange. Yet, the exchange procedure is not without risk and the risk of re-thrombosis (34%), stroke (29%), postoperative dialysis (29%) and perioperative complications remains high.

Although rare, recovery of cardiac function after mechanical support of the left ventricle is the most desirable therapeutic goal in the treatment of end-stage heart failure.Herein, we present a novel implantable device for explantation of the HeartMate 3™ left ventricular assist device (LVAD) in patients, following cardiac recovery, avoiding (re-) sternotomy.This article demonstrates the feasibility of applying this novel device, which fits into the sewing ring of the LVAD.This custom-made mechanical plug offers a promising alternative to standard device-explantation procedures.

OBJECTIVES The amount of intense and focused training with the specific goal to improve performance (i.e. deliberate practice) is a predictor of expert-level performance in multiple domains of psychomotor skill learning. Simulation training improves surgical skills in cardiac surgery. We established a training programme that enables early surgical exposure and assessment. We investigated the training effects in coronary surgery simulations in trainees with different levels of surgical experience. METHODS The early surgical exposure and assessment programme comprises a low- and high-fidelity simulation, self-organized training, instructed workshops and a stepwise challenge increase. Performance was assessed with a multidimensional skill matrix using video recordings. Two groups of trainees [students (N = 7), 1-/2-year residents (N = 6)] completed introductory training (pretraining, level 1) and two 3-week training periods (levels 2 and 3). Fellows (N = 6) served as controls. Residents and students underwent deliberate practice training with specific training targets. Fellows performed regularly scheduled coronary surgery cases. Entry and exit assessments were conducted for levels 2 and 3. RESULTS Fellows did not improve overall performance. Residents and students showed significant improvements in both technical accuracy and completion times. Residents reached an overall performance level comparable to fellows. Students reached similar accuracy of surgical skills with longer completion times [level 3 exit score/time: fellows 27 (24–29)/min; residents 27 (21–30)/min, P = 0.94; students 17 (17–25)/min, P = 0.068]. CONCLUSIONS Deliberate practice training resulted in a fast and substantial increase in surgical skills in residents and students. Unexperienced residents reach performance levels of fellows. Deliberate practice simulation programmes should be a mandatory component of surgical training.

LVAD implantation improves kidney function in patients with renal dysfunction. A considerable difference in the change of renal parameters was detected in patients with LIS as compared to SAS, which was not significant possibly due to the limited size of the patient cohort (n=13).

Ventricular arrhythmias occurred in 13% of the investigated patients. LVEF improved significantly after 3 months, and thus a permanent ICD implantation was avoided in several cases. Sternotomy did not impair wearing time of the WCD. A WCD can effectively protect patients against ventricular tachyarrhythmias after cardiac surgery.