Approaches to ventricular assist device exchange: Resternotomy versus limited incisions

Commentary: Sine qua non of a left ventricular assist device exchange: Consideration of patient, pathology, and pump

“…In this issue, Osho and D'Alessandro 3 describe various surgical approaches for an LVAD exchange. This overview is timely, especially given the recent Food and Drug Administration Class I recall of the HeartWare HVAD.…”

“…In patients in whom the issue is limited to the outflow graft, a reoperative sternotomy or a limited incision may be suitable, depending on the extent of graft involvement ( Figure 1 ). 3

Figure 1 Suggested surgical approaches based on the surgical pathology.

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“…The overview and algorithm proposed by Osho and D'Alessandro 3 is comprehensive, timely, and illuminating. The commentary about the potential use of cerebral protection devices, which have been used in an off-label manner for other cardiac indications, 4 is particularly instructive.…”

Commentary: The principal of the five P's

“…In this issue of JTCVS Techniques , Osho and D'Alessandro 2 discuss scenarios leading to LVAD exchange and the current surgical options. Rather than a one-size-fits-all strategy, they propose thoughtful consideration of all available approaches, weighing patient, device, disease, and institutional factors.…”