Exchange of DuraHeart left ventricular assist device via a subcostal approach

We report a successful case of a DuraHeart left ventricular assist device (LVAD) exchange via a subcostal approach. A 35-year-old woman was implanted with a DuraHeart LVAD due to dilated cardiomyopathy. Approximately 8 months after the implantation, the magnetic levitation system failed. The DuraHeart LVAD was exchanged emergently. The pump was freely dissected via a subcostal approach, avoiding redo sternotomy. De-airing of the new pump and the left ventricle was carefully performed. When the systemic flow was transferred from the cardiopulmonary bypass to the DuraHeart LVAD, an adequate flow was not initally obtained. Positional correction of the inflow conduit was needed to obtain full systemic flow. The postoperative course was uneventful. She was successfully discharged and is waiting at home for a heart donation.