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Objectives: Patients who successfully demonstrate the ability to wean from LVAD are candidates for LVAD explant, which is conventionally performed through a median sternotomy, with cardiopulmonary bypass. In this video, we describe the technical aspect of explantation of a HeartWare HVAD centrifugal device, through a small anterior thoracotomy, without cardiopulmonary bypass.
Methods and Results: A 41 year-old male with previous aortic replacement with a homograft for endocarditis at age 19. At age 21, a redo AVR with a bioprosthesis was performed. He presented with CHF and depressed EF of 20%, secondary to severe prosthetic AS and AI. He underwent transapical aortic valve-in-valve implantation. Unfortunately, ventricular valve embolization occurred, requiring emergent conversion. He developed post-cardiotomy shock requiring ECMO support and was bridged to a HeartWare HVAD. Myocardial recovery occurred and explantation was performed. A small left thoracotomy was performed, outflow graft was stapled and divided, pump explanted and apical inflow plugged with a titanium plug. No blood product were used and patient was extubated in OR and discharged home on day 3.
Conclusions: In complex patients with multiple previous surgery, a minimally invasive off-pump approach to LVAD explant may reduce peri-operative morbidity and mortality