Conventional and alternative sites for left ventricular assist device inflow and outflow cannula placement

Loforte, Antonio; Bottio, Tomaso; Attisani, Matteo; Suàrez, Sofia Martìn; Tarzia, Vincenzo; Pocar, Marco; Botta, Luca; Gerosa, Gino; Rinaldi, Mauro; Pacini, Davide

doi:10.21037/acs-2020-cfmcs-28

Cited by 5 publications

(24 citation statements)

References 20 publications

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“…Outflow graft compression can effectively be avoided using a ring-reinforced Gore-Tex graft at the site of passage through the intercostal space, as previously described. 7 Finally, the LSA caliber reduction after placing a permanent banding distal to the outflow graft anastomosis seemed to be effective in preventing overflow to the left arm, without compromising arm vascularization. In fact, we have observed no complications such as arm swelling or dysfunction or change of pump variables with this technique.…”

Section: Discussionmentioning

confidence: 95%

“…Outflow graft compression can effectively be avoided using a ring‐reinforced Gore‐Tex graft at the site of passage through the intercostal space, as previously described 7 …”

Section: Discussionmentioning

confidence: 99%

“…In an effort to preserve the sternum or avoid difficult re‐entries after previous cardiac operations, less invasive surgical approaches have been recently described 3,4 . Moreover, alternative sites for outflow graft anastomosis are increasingly reported as acceptable options, particularly after previous cardiac surgery or when ascending aorta is severely diseased 5–7 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 Moreover, alternative sites for outflow graft anastomosis are increasingly reported as acceptable options, particularly after previous cardiac surgery or when ascending aorta is severely diseased. [5][6][7] We herein describe a case series of three LVAD patients, in which the left subclavian artery (LSA) was employed as an outflow graft anastomosis site, and the LVA was approached through a mini-thoracotomy. This surgical strategy was considered to limit operative risks in selected severely ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Left subclavian artery as an alternative site for left ventricular assist device outflow graft in challenging situations

et al. 2022

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Left ventricular assist device (LVAD) has emerged as an effective surgical therapy for end-stage heart failure. 1,2 The standard operative approach consists of a full median sternotomy, and during cardiopulmonary bypass, the LVAD is implanted by inserting the inflow cannula inside the left ventricle apex (LVA) and anastomosing the outflow graft to the ascending aorta. In an effort to preserve the sternum or avoid difficult re-entries after previous

show abstract

Section: Discussionmentioning

confidence: 95%

“…Outflow graft compression can effectively be avoided using a ring‐reinforced Gore‐Tex graft at the site of passage through the intercostal space, as previously described 7 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left subclavian artery as an alternative site for left ventricular assist device outflow graft in challenging situations

et al. 2022

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“…Through a left mini-thoracotomy in the fifth intercostal space, the HVAD (HeartWare, Medtronic, Minneapolis, MN, USA) or Heartmate III (Abbott, Abbott Park, IL, USA) device was implanted on the beating heart on CPB/ECMO. A right anterior mini-thoracotomy was performed in the second intercostal space and the outflow graft was anastomosed to the ascending aorta [ 14 ]. The LVAD support was started and the patient was gently weaned from CPB/ECMO.…”

Section: Methodsmentioning

confidence: 99%

Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure

Tarzia

Ponzoni

Pittarello

et al. 2022

JCM

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We propose a patient-tailored strategy that considers the risk for postoperative right heart failure, utilizing the percutaneous ProtekDuo cannula (Livanova, London, UK) in an innovative way to perform cardiopulmonary bypass during LVAD implantation in ECMO patients. Our novel protocol is based on the early intra-operative use of the ProtekDuo cannula, adopting the distal lumen as the pulmonary vent and the proximal lumen as the venous inflow cannula during cardiopulmonary bypass. This configuration is rapidly switched to the standard fashion to provide planned postoperative temporary right ventricular support, in selected patients at high risk of right ventricular failure. From September 2020 to June 2022, six patients were supported with the ProtekDuo cannula during and after an intracorporeal LVAD implantation (five of which were minimally invasive): four HeartMate III (Abbott, U.S.A.) and two HVAD (Medtronic Inc, MN). In all cases, the ProtekDuo cannula was correctly positioned and removed without complications after a median period of 8 days. Non-fatal bleeding (bronchial hemorrhage) occurred in one patient (17%) during biventricular support. Thirty-day mortality was 0%. From this preliminary work, our novel strategy demonstrated to be a feasible solution for planned minimally invasive right ventricular support in ECMO patients scheduled for a durable LVAD implantation.

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Flow assessment as a function of pump timing of tubular pulsatile pump for use as a ventricular assist device in a left heart simulator

Sharifi

Bark

2022

Artificial Organs

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Introduction Although mechanical circulatory support saved many lives during the last decade, clinical observations have shown that the continuous flow pumps are associated with a much higher incidence of gastrointestinal bleeding and kidney problems, among others, compared with the earlier generation pulsatile pumps. However, the presence of several moving mechanical components made pulsatile pumps less durable, bulky, and prone to malfunction, ultimately leading to bias in favor of continuous flow designs. Objective The aim of the current work is to create a prototype tubular pulsatile pump and to test the timing of the pump in a left heart simulator. Methods A left heart simulator to mimic pumping from a failing heart was created. This was used to experimentally test the output of a prototype ventricular assist device relative to a failing heart in the form of flow and pressure. The effect of pulsation timing was quantified. Results A failing heart was simulated with an average flow rate of 1.1 L/min and a systolic pressure of 47 mm Hg. With the pump, the flow rate increases to 4.8 L/min and a systolic pressure of 110 mm Hg, in a copulsation mode, while activating for 300–400 ms. If the activation time is reduced, or increased, the pump becomes less effective. Load on the heart is reduced when the pump operates in a counterpulsation mode. Conclusion A pulsatile pump, like the one proposed, provides adequate output for mechanical circulatory support, while minimizing the number of moving parts that could otherwise lead to tribological wear.

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Conventional and alternative sites for left ventricular assist device inflow and outflow cannula placement

Cited by 5 publications

References 20 publications

Left subclavian artery as an alternative site for left ventricular assist device outflow graft in challenging situations

Left subclavian artery as an alternative site for left ventricular assist device outflow graft in challenging situations

Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure

Flow assessment as a function of pump timing of tubular pulsatile pump for use as a ventricular assist device in a left heart simulator

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