Pre-transplant ventricular assist device explant

Annals of Cardiothoracic Surgery
Espeed Khoshbin, Stephan Schueler

Abstract

Explantation of a left ventricular assist device (LVAD) may be challenging even in the most experienced hands. We aim to describe the technique for explantation of an LVAD together with the heart as applicable to all contemporary implantable mechanical assist devices. In order to ensure safe explantation, particular care must be taken at three distinct stages: at the time of LVAD implantation, at pre-transplant assessment and at the time of heart transplantation. The preparation for a safe explantation at LVAD implantation includes positioning the driveline and the outflow graft away from the back of the sternum to ensure protection from injury during re-entry into the chest. At transplant assessment, essential investigations include computed tomography (CT) of the chest and ultrasound imaging of femoral vessels. At the time of heart transplantation, the site of peripheral access should be prepared and vessels exposed in case of a need for emergency bypass. We advise careful dissection starting from the lower aspect of the under surface of the sternum, moving as proximally as possible before attempting to use the oscillating saw. Much of the dissection of the heart is done off-pump. Cardiopulmonary bypass may be established eit...Continue Reading

Citations

Jul 20, 2019·Interactive Cardiovascular and Thoracic Surgery·Steven HsuAhmet Kilic
Feb 26, 2021·The Annals of Thoracic Surgery·Yukiharu SugimuraPayam Akhyari
Oct 29, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Ismael A Salas De ArmasIgor D Gregoric

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