Titanium Fastener Utilization During Magnetically Levitated Centrifugal Flow Left Ventricular Assist Device Implantation
Carl A. Johnson, Jr., Amber L. Melvin, Hossein Amirjamshidi, Davida A. Robinson, Peter A. Knight, Igor Gosev.
University of Rochester Medical Center, Rochester, NY, USA.
Objective: Titanium fasteners (TF) are used frequently in cardiac surgery and have been shown to decrease aortic cross-clamp and cardiopulmonary bypass (CPB) time in valve surgery when compared to hand tied (HT) knots. Furthermore, the compression force of knots secured with TF are higher and more uniform when compared to HT knots. TF usage has facilitated minimally invasive valve surgery and may facilitate a minimally invasive left ventricular assist device (LVAD) implant. The objective of this study is to demonstrate the feasibility of TF to secure the inflow sewing ring in magnetically levitated (mag-lev) centrifugal flow LVAD implants. Methods: An in-vitro assessment of the clearance between the sewing ring secured with TF and the mag-lev LVAD was conducted. Patients (n=25) undergoing mag-lev LVAD implantation at a single center were reviewed. The sewing cuff of the inflow graft was secured with HT knots (n=19) or TF (n=6). The primary objective was to demonstrate if TF could secure the LVAD inflow sewing ring intraoperatively. The secondary objective was to compare CPB times between the HT and TF groups. The implantation technique did not differ between the groups. A standard sternotomy incision was made. Central arterial and venous cannulation was performed and CPB initiated. The left ventricle was cored and the sewing ring was attached with HT knots or TF. The LVAD was connected. The outflow graft anastomosis was performed and the LVAD was initiated. Results: There was adequate clearance for the TF to secure the inflow sewing ring and then connect to the LVAD in vitro (Figure 1). The inflow sewing ring was secured successfully and connected to the LVAD inflow in all of the TF patients (Figure 1). CPB times were 74 min for the TF group and 90 min for the HT group (p>0.05). Conclusions: The inflow sewing ring of mag-lev centrifugal flow LVADs may be safely secured using TF. TF may result in shorter CPB times. 
Figure 1: Top: Benchtop photo of sewing ring secured with titanium fasteners (TF) and attached to the left ventricular assist device (LVAD) Bottom: Intraoperative photo of LVAD sewing ring secured with TF.
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