Ventricular assist devices implantation: surgical assessment and technical strategies

Abstract

Along with the worldwide increase in continuous left ventricular assist device (LVAD) strategy adoption, more and more patients with demanding anatomical and clinical features are currently referred to heart failure (HF) departments for treatment. Thus surgeons have to deal, technically, with re-entry due to previous cardiac surgery procedures, porcelain aorta, peripheral vascular arterial disease, concomitant valvular or septal disease, biventricular failure. New surgical techniques and surgical tools have been developed to offer acceptable postoperative outcomes to all mechanical circulatory support recipients. Several less invasive and/or thoracotomic approaches for surgery combined with various LVAD inflow and outflow graft alternative anastomotic sites for system placement have been reported and described to solve complex clinical scenarios. Surgical techniques have been upgraded with further technical tips to preserve the native anatomy in case of re-entry for heart transplantation, myocardial recovery or device explant. The current continuous-flow miniaturized and intrapericardial devices provide versatility and technical advantages.However, the surgical planning requires a careful multidisciplinary evaluation which must be driven by a dedicated and well-trained Heart Failure team. Biventricular assist device (BVAD) implantation by adoption of the newer radial pumps might be a challenge. However, the results are encouraging thus remaining a valid option. This paper reviews and summarizes LVAD preoperative assessment and current surgical techniques for implantation.

Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review

“…Finally, as a note, while peripheral artery disease is not a contraindication, these patients are at a higher risk for numerous complications ( 34 ) and should be assessed on an individual basis for a suitable access strategy. Appropriate assessments may include angiography, intravascular ultrasound imaging ( 35 ), and computed tomography ( 36 ).…”

Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy

“…While the apex is favoured for LVAD inflow cannula insertion, anatomical complications such as apical aneurysm can restrict its use as a preferred insertion site. The inferior LV wall could be an alternative graft site when surgeons are challenged with a geometrically impaired dilated LV and apical aneurysm (Loforte et al, 2021; Potapov et al, 2019). In cases where challenged with hypertrophic cardiomyopathy, thin ventricle walls and/or LV wall calcification, left atrium (LA) is mandated as an inflow cannula graft site (Kiamanesh et al, 2020; Osaki et al, 2009).…”

Inflow from a Cardiopulmonary Assist System to the Pulmonary Artery and Its Implications for Local Hemodynamics—a Computational Fluid Dynamics Study

“…Graft anastomoses are a widely used connection method in various indications. An end-to-side anastomosis to the PA is already an established procedure in the use of right ventricular assist devices (RVADs) [ 6 , 7 ] and is equally conceivable for patients with long-term pulmonary support.…”