Back to Annual Meeting ePosters

OBJECTIVE: CentriMag VADs can be utilized for temporary support of the failing ventricle. We have utilized these devices in multiple configurations ranging from completely minimally invasive placement and removal to placement through a full sternotomy with transcutaneous cannula access via the intercostal spaces allowing for sternal closure.
METHODS: As an example of completely off-pump, minimally invasive approach, a patient in cardiogenic shock underwent a mini-thoracotomy in the right third interspace. A pericardiotomy was performed. Purse strings were placed in the aorta and right superior pulmonary vein. Under transesophageal echo (TEE) guidance, a 20 French wire-wrapped cannula was placed into the ascending aorta over a wire. Similarly, a 29 French multi-holed cannula was placed via the right superior pulmonary vein into the left atrium and across the mitral valve into the LV under TEE guidance. Cannulas were connected to the LVAD circuit and flow was established (Figure1A). The interspace was reapproximated. The incision was closed in layers. As an example of placement through a sternotomy with transcutaneous cannula access via the intercostal spaces, a patient developed RV failure after LVAD placement that was unrelieved by re-opening the sternotomy. Pledgeted sutures were placed in the right atrium and PA. A 31 French metal-tipped cannula was brought through an intercostal space on the right, inserted into the atrium and secured. An 18 French arterial cannula was brought through an intercostal space on the left, introduced into the PA and secured (as depicted in Figure1B). The cannulas were connected to the RVAD and flow was established. The sternum was closed.
RESULTS: Immediate improvements in hemodynamics were observed in these cases. After percutaneous coronary revascularization, the LVAD was removed from the first patient via a minimally invasive approach. In the other scenario, the device was removed via sternotomy. Transcutaneous cannula access via the interspaces allowed the patient get out of bed and sit up before device removal.
CONCLUSIONS: Various minimal access strategies can be effectively utilized during CentriMag VAD placement.