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J Thorac Cardiovasc Surg 2004;127:262-264
© 2004 The American Association for Thoracic Surgery

Brief communication

Off-pump technique for insertion of a HeartMate vented electric left ventricular assist device

^a Division of Cardiac and Thoracic Surgery, Department of Surgery, Temple University Hospital, Philadelphia, Pa, USA

Received for publication July 23, 2002; accepted for publication November 26, 2002.

^* Address for reprints: Satoshi Furukawa, MD, Chief, Division of Cardiac and Thoracic Surgery, Surgical Director, Cardiopulmonary Transplantation, Department of Surgery, 300 Parkinson Pavilion, 3401 N Broad St, Philadelphia, PA 19140, USA
furukas@tuhs.temple.edu

The first 20% of the full text of this article appears below.

The number of patients awaiting heart transplantation has increased exponentially during the past 10 years, while the number of donor organs has remained unchanged ¹. Alternatives to cardiac transplantation, such as left ventricular assist devices (LVADs), have been shown to decrease mortality and increase the quality of life in patients with end-stage heart failure ². It has recently been proposed that these devices may become a destination therapy for patients with end-stage heart failure and thus allow definitive treatment for those who otherwise may not be able to receive or qualify for heart transplantation ³.

Cardiopulmonary bypass (CPB) is routinely required for implantation of LVADs. However, the well-described complications of CPB may exacerbate multiple organ failure and increase blood product transfusions during and after the operation. Recent technologic advances, including cardiac stabilization devices, have allowed coronary artery bypass surgery to be performed without CPB. We present a technique for insertion without cardiopulmonary bypass of a HeartMate Vented Electric LVAD (Thoratec Corporation, Pleasanton, Calif).

Methods

Clinical summary
A 60-year-old man was awaiting heart transplantation because of severe end-stage heart failure with dilated cardiomyopathy. The patient had no history of previous cardiac operations or percutaneous coronary angioplasties. Decompensation of his heart failure required transfer to the cardiac intensive care unit and inotropic support with dobutamine (10 µg/[kg · min]), milrinone (0.2 µg/[kg · min]), and intra-aortic balloon pulsation. His cardiac index was 1.6 L/(min · m²). Transthoracic echocardiography revealed biventricular dilatation with an ejection fraction of 5% and a left ventricular end-diastolic dimension of 5.9 cm. Mild-to-moderate mitral regurgitation was evident, and no aortic regurgitation was noted. Because no donor heart was available, the decision was made to place the LVAD.

Operative technique
The patient was transported to the operating room for . . . [Full Text of this Article]

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