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Off-Pump Implantation of the HeartWare HVAD Left Ventricular Assist Device Through Minimally Invasive Incisions

https://doi.org/10.1016/j.athoracsur.2010.08.031Get rights and content

Implantation of left ventricular assist devices through small incisions, avoiding cardiopulmonary bypass, may decrease the activation of the inflammatory and coagulation cascades and decrease bleeding and vasoplegia. One patient with severe, inotrope-dependant cardiomyopathy received the HeartWare left ventricular assist device (HeartWare Inc, Framingham, MA) through an upper ministernotomy and left minithoracotomy. The outflow graft was connected to the ascending aorta, and the inflow of the left ventricular assist device was attached through to the apex of the heart. The apical puncture was performed under rapid ventricular pacing, followed by insertion of the inflow of the pump. The patient was extubated rapidly and discharged home 14 days later.

Section snippets

Patient

Recurrent episodes of decompensated heart failure requiring inotropic support developed in a 48-year-old woman with ischemic cardiomyopathy. Her echocardiogram showed an ejection fraction of 0.15, with dilatation of the left ventricle (end-diastolic dimension, 64 mm). The patient did not tolerate weaning of the inotropes, which led to the decision to implant a long-term LVAD. The patient was scheduled to receive a HVAD device under Canadian special access protocol.

Device

The HVAD is a small

Comment

The patient in this report received the HVAD through minimal incisions, without the use of CPB. The implantation of this device without the use of CPB was reported in only 2% of the cases of the early European and Australian experience [4], and a full sternotomy was used in 86%. Other authors have inserted the HeartMate II (Thoratec, Pleasanton, CA) or the Jarvik 2000 (Jarvik Heart, New York, NY) through a combination of subcostal incision and ministernotomy, with or without the use of CPB [1].

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