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Minimally Invasive Axial Flow to Centrifugal Flow LVAD Exchange - First in Man
Amit K. Taggarse, David Lyle Joyce.
Mayo Clinic, Rochester, MN, USA.

OBJECTIVE: Left Ventricular Assist Device (LVAD) thrombosis represents an increasingly frequent problem in patients with axial flow devices. In some cases, exchange to a centrifugal flow device is required. Redo sternotomy has been described in all of the previously reports for this technique. We developed a minimally invasive strategy for axial to centrifugal flow device exchange using a limited subcostal incision.
METHODS: Cannulation for CPB is performed via the right groin. A limited left subcostal incision is made to facilitate removal of the axial flow device from the silastic sheath, which is trimmed to accommodate the centrifugal flow device. After securing the centrifugal flow LVAD, an end-to-end anastomosis is performed to the existing outflow graft.
RESULTS: We employed this technique in a critically ill 50 year old female who had a difficult course after axial flow device implantation complicated by LVAD thrombosis 66 days after her LVAD implantation. Following minimally invasive device exchange, her LDH levels improved from 2820 to 290 U/L.
CONCLUSIONS: Application of minimally invasive approaches to LVAD exchange represents an appealing alternative to redo sternotomy, particularly among patients that are unlikely to tolerate a major surgical procedure. By minimizing dissection through a subcostal approach with retention of the inflow cannula sleeve, device exchange can be accomplished with minimal morbidity.

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