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Preperitoneal insertion of the HeartMate 1000 IP implantable left ventricular assist device
P M McCarthy1, N Wang, R Vargo
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195.
Insights
Preperitoneal insertion of the HeartMate left ventricular assist device (LVAD) offers a safe alternative to abdominal placement for patients with cardiogenic shock awaiting heart transplantation. This approach may reduce complications associated with intra-abdominal LVAD implantation.
Area of Science:
- Cardiology
- Surgical Innovation
- Mechanical Circulatory Support
Background:
- Patients with cardiogenic shock often require left ventricular assist devices (LVADs) as a bridge to heart transplantation.
- Intra-abdominal placement of LVADs can lead to complications such as gastrointestinal issues and device migration.
- Alternative implantation sites are being explored to improve patient outcomes and reduce morbidity.
Purpose of the Study:
- To evaluate the safety and feasibility of preperitoneal insertion of the HeartMate 1000 IP left ventricular assist device.
- To assess potential complications and outcomes associated with this novel implantation technique.
Main Methods:
- A prospective study involving 12 consecutive patients with cardiogenic shock awaiting heart transplantation.
- Insertion of the HeartMate 1000 IP LVAD into a preperitoneal pocket, situated between abdominal muscles and the posterior rectus sheath.
- Monitoring of patient hemodynamics, device performance, and post-operative complications.
Main Results:
- The HeartMate 1000 IP LVAD fit easily into the preperitoneal pocket in all 12 patients.
- Seven patients (58%) underwent successful heart transplantation after a mean support duration of 55 days, with improved cardiac index.
- One patient experienced a driveline infection requiring revision, but ultimately had a successful transplant; all transplanted patients are alive and well.
- One patient died from progressive multiorgan failure; four patients remain on LVAD support.
Conclusions:
- Preperitoneal insertion of the HeartMate LVAD is a safe and feasible surgical approach.
- This technique may mitigate risks associated with traditional intra-abdominal LVAD implantation.
- The preperitoneal site provides adequate space and facilitates device explantation during transplantation.
Abstract:
During a 16-month period, 12 consecutive patients underwent insertion of a HeartMate 1000 IP left ventricular assist device in a preperitoneal pocket that separated the device from the abdomen. All patients were in cardiogenic shock awaiting heart transplantation. Preoperatively, the mean cardiac index was 1.6 L.min-1.m-2, with 11 patients on intraaortic balloon pump support and 2 on extracorporeal membrane oxygenation. The pocket was formed below the rectus abdominis and internal oblique muscles and above the posterior rectus sheath. The pump fit easily in all patients. One patient died of progressive multiorgan failure. Four patients are still on support. Seven patients underwent successful transplantation after a mean duration of 55 days of support (mean pump index was 3.1 L.min-1.m-2 during support). One patient had driveline revision because of an exit site infection but had successful transplantation. The pump was explanted without difficulty at each transplant operation. All patients having transplantation are alive and well. Preperitoneal insertion of the HeartMate left ventricular assist device can be safely performed and may avoid problems posed by intraabdominal left ventricular assist device insertion.