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A Right Ventricular Assist Device Implantation Technique that does not necessitate Resternotomy at the Time of Explantation
Diyar Saeed, Alexander Albert, Hiroyuki Kamiya, Artur Lichtenberg.
Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
OBJECTIVE:
Resternotomy is usually required to explant a temporary right ventricular assist device (RVAD) after recovery of the right ventricle (RV).
METHODS:
We are describing a technique of RVAD implantation that does not necessitate resternotomy at the time of RVAD removal: Using percutaneous puncture of the femoral vein for the implantation of the RVAD inflow cannula and anastamosing the RVAD outflow graft to the pulmonary artery. The outflow graft is passed transcutanously through a separate opening to allow later removal (Figure 1).
RESULTS:
Five patients (57 ± 22 yo) were supported at our institution using this technique for RV failure (RVF). Three patients had RVF after left ventricular assist device (LVAD) implantation and 2 patients had isolated postcardiotomy RVF. The etiology of heart failure was ischemic cardiomyopathy in 4 patients and dilatative cardiomyopathy in 1 patient. Levitronix CentriMag system was used as a RVAD. The duration of RVAD support was (26 ± 35) days. In patient #1 and 3, the RVAD was successfully removed following gradual reduction of RVAD support. Patient # 2 and #4 were successfully transplanted 7 and 88 days after LVAD/RVAD implantation and prior to full recovery of RV function. Patient #5 is still ongoing. No mobilization issues were observed during RVAD support. On the day of RVAD explantation, the patients were returned to the operating room and minimal anesthesia was administrated. The inflow and outflow cannulae were clamped. The stretchable outflow graft of the RVAD was carefully pulled up to 5 cm. Multiple ligations were applied and the insertion site is secondarily closed. Finally, the RVAD inflow cannula was removed after inserting a deep U-stich and direct pressure application. Follow up CT scan 33 days after RVAD removal in patient #1 showed clotting of the distal end of the graft.
CONCLUSIONS:
Using the above described RVAD implantation technique, RVAD removal can be reproducibly performed under minimal anesthesia and without the need of resternotomy.
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