HeartWare Left Ventricular Assist Device Implantation Through Bilateral Anterior Thoracotomy

Popov, Aron Frederik; Hosseini, Majid; Zych, Bartłomiej; Simon, Andrè; Bahrami, Toufan

doi:10.1016/j.athoracsur.2011.09.055

Cited by 93 publications

(64 citation statements)

References 6 publications

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“…For example, some alternative techniques avoid re-sternotomy hence allowing a reciprocating saw to be used on a virgin sternum at the time of transplantation. In this technique implantation is performed through bilateral thoracotomies (8). In brief, the patient is placed supine on cardiopulmonary bypass through femoro-femoral cannulation.…”

Section: Clinical Resultsmentioning

confidence: 99%

Pre-transplant ventricular assist device explant

Khoshbin¹,

Schueler²

2018

Ann. Cardiothorac. Surg.

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Explantation of a left ventricular assist device (LVAD) may be challenging even in the most experienced hands. We aim to describe the technique for explantation of an LVAD together with the heart as applicable to all contemporary implantable mechanical assist devices. In order to ensure safe explantation, particular care must be taken at three distinct stages: at the time of LVAD implantation, at pre-transplant assessment and at the time of heart transplantation. The preparation for a safe explantation at LVAD implantation includes positioning the driveline and the outflow graft away from the back of the sternum to ensure protection from injury during re-entry into the chest. At transplant assessment, essential investigations include computed tomography (CT) of the chest and ultrasound imaging of femoral vessels. At the time of heart transplantation, the site of peripheral access should be prepared and vessels exposed in case of a need for emergency bypass. We advise careful dissection starting from the lower aspect of the under surface of the sternum, moving as proximally as possible before attempting to use the oscillating saw. Much of the dissection of the heart is done off-pump. Cardiopulmonary bypass may be established either through peripheral vessels or the outflow graft in an emergency. Central direct cannulation is then established. After the heart and major vessels are isolated, explantation of the heart may begin either en-bloc or after splitting the ventricles in a sagittal plane. The basal regions of both ventricles and both atria are removed, leaving generous cuffs for anastomosis of the left atrium, pulmonary artery, aorta, inferior and superior vena cava (SVC). The apex of the heart is then removed with the device taking care not to injure the phrenic nerve.

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Section: Clinical Resultsmentioning

confidence: 99%

Pre-transplant ventricular assist device explant

Khoshbin¹,

Schueler²

2018

Ann. Cardiothorac. Surg.

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“…The heart is accessed by median sternotomy, although thoracotomy and subcostal approaches are also described (23,24). Patients with prior sternotomy experience longer cardiopulmonary bypass time and more bleeding (25).…”

Section: Surgical and Device Implantationmentioning

confidence: 99%

Left Ventricular Assist Device Management in the ICU

Pratt

Shah

Boyce

2014

Critical Care Medicine

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Intensivists are increasingly likely to encounter patients requiring mechanical circulatory support with left ventricular assist devices at various points in the trajectory of their disease, from the immediate postimplant period to subsequent admissions for complications, and at end of life. A basic understanding of left ventricular assist device physiology is essential to the safe and effective care of these patients.

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“…B. im Fall einer Porzellanaorta oder von reoperativen Eingriffen Alternativen zur Standardimplantationsmethode [9,[12][13][14][15][16][17][18][19].…”

Section: Minimalinvasive Implantationunclassified