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Published on: May 11, 2018
Left ventricular assist device outflow graft: alternative sites
Magdy M El-Sayed Ahmed1, Muhammad Aftab1, Steve K Singh1
11 Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA ; 2 Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt ; 3 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Three alternative sites for left ventricular assist device (LVAD) outflow grafts—supraceliac abdominal aorta, innominate artery, and left axillary artery—are presented as safe options for complex cases, offering solutions for challenging aortic or chest conditions.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Surgical Techniques
Background:
- Standard left ventricular assist device (LVAD) implantation can be challenging due to heavily calcified ascending aortas or hostile chest environments.
- Previous sternotomy, radiation, or complex aortic pathology necessitates alternative surgical strategies for LVAD outflow graft anastomosis.
Purpose of the Study:
- To describe and evaluate three alternative arterial sites for LVAD outflow graft connection.
- To present viable options for LVAD implantation when standard ascending aortic anastomosis is not feasible or carries high risk.
Main Methods:
- Case series detailing three distinct LVAD outflow graft implantation strategies.
- Approach 1: Supraceliac abdominal aorta via left subcostal incision in a patient with prior chest radiation and surgery.
- Approach 2: Innominate artery in a patient with a porcelain ascending aorta, combined with other cardiac procedures.
- Approach 3: Left axillary artery in a patient with a history of infected LVAD pseudoaneurysm at the aortic anastomosis.
Main Results:
- Successful LVAD outflow graft implantation was achieved using the supraceliac abdominal aorta, innominate artery, and left axillary artery in selected high-risk patients.
- These alternative sites provided viable conduits for LVAD support when the ascending aorta was unsuitable.
- The sternotomy-sparing approach for the abdominal aorta facilitated LVAD implantation in a patient with extensive chest wall issues.
Conclusions:
- The supraceliac abdominal aorta, innominate artery, and left axillary artery represent safe and effective alternative sites for LVAD outflow graft anastomosis.
- These approaches are recommended for specific patient populations facing high risks associated with standard surgical techniques.
- Careful patient selection is crucial to maximize the benefits and mitigate the inherent risks of these alternative LVAD implantation strategies.
