Pre-transplant ventricular assist device explant

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support

Background:

• Explantation of left ventricular assist devices (LVADs) can be complex, even for experienced surgeons.
• A systematic approach is crucial for safe removal of LVADs during heart transplantation.

Purpose of the Study:

• To describe a standardized technique for explanting LVADs along with the heart.
• To provide guidance applicable to contemporary implantable mechanical assist devices.

Main Methods:

• Preparation during LVAD implantation: positioning driveline and outflow graft away from the sternum.
• Pre-transplant assessment: utilizing CT scans and ultrasound imaging.
• Surgical technique: careful dissection, off-pump procedures, and potential use of peripheral cardiopulmonary bypass.

Main Results:

• The described technique facilitates safe explantation of LVADs and the heart.
• Key steps include meticulous dissection, strategic cannulation, and precise removal of cardiac structures.

Conclusions:

• Safe LVAD explantation is achievable through meticulous planning and execution at distinct surgical stages.
• The technique ensures adequate cuffs for subsequent anastomosis during heart transplantation.