An alternative approach to explantation and exchange of the heartware left ventricular assist device

Mohammad Sajjad, Tanveer Butt, Faruk Oezalp, Aleem Siddique, Neil Wrightson, David Crawford, Thasee Pillay, Stephan Schueler

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

OBJECTIVES: Left ventricular assist device (LVAD) explantation and exchange is a relatively infrequent but potentially complex procedure. Patients requiring such procedures have multisystem suboptimal physiological reserve due to end-stage heart failure and are prone to complications. Less-invasive procedures are believed to facilitate postoperative recovery and early mobilization. We describe an alternative approach to explantation and exchange of the HeartWare LVAD through left thoracotomy. METHODS: Six patients (M = 4, F = 2, mean age = 49.16 years) underwent device explant/exchange or initial implant (explant = 2, exchange = 3, initial implant = 1) through left thoracotomy utilizing cardiopulmonary bypass and induced ventricular fibrillation (VF). The mean bypass time and mean VF arrest time were 82 and 3 min, respectively. A new outflow graft was anastomosed to the previous outflow graft in 3 cases of device exchange and to the descending aorta in 1 case of initial implant. RESULTS: One patient died in the intensive care unit due to unrelated causes (gram-negative sepsis) after device exchange. All others were discharged alive and currently remain on follow-up. The mean length of hospital stay was 40.66 days. CONCLUSIONS: On-pump approach through single thoracotomy incision is safe and equally suitable for device explant, exchange and initial implant. However, structural heart defects requiring surgical correction and the requirement of simultaneous right ventricular assist device are the limitations of this approach.

Original languageEnglish (US)
Article numberezs585
Pages (from-to)1247-1250
Number of pages4
JournalEuropean Journal of Cardio-thoracic Surgery
Volume43
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • Explantation/exchange
  • Heartware left ventricular assist device
  • Thoracotomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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