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. 2005 Dec;37(4):373-6.

Immediate post-LVAD implant support: two approaches

Phillip L Syracuse  1 , Carolyn Yager, Nicholas Smedira, Robert M Savage
Affiliations

Immediate post-LVAD implant support: two approaches

Phillip L Syracuse et al. J Extra Corpor Technol. 2005 Dec.

Abstract

Increased use of left ventricular assist devices (LVAD) as bridges to transplant has revealed the need for short-term right heart support for deairing and right ventricular recovery. The two approaches described are implemented as the patient is weaned from regular cardiopulmonary bypass. Dependent on patient needs, the surgeon may select a high-flow or low-flow approach to what is essentially right heart bypass. Both methods use the existing venous drainage from the right side of the heart. The higher flow returns blood through a 0.25-in tube connected to a modified adult vent (AV) to the pulmonary artery (PA). This provides flows as high as 3.5 L/min. The low-flow method uses the cardioplegia line, which goes unused during LVAD insertion. It is attached to the same modified AV cannula, placed into the PA, with flows between 400 and 600 ml/min. Each method has its advantages, disadvantages, and quirks. The results are functionally successful in allowing support of the right heart and deairing of the ventricular device.

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Conflict of interest statement

The senior author has stated that authors have reported no material, financial or other relationship with any healthcare-related business or other entity whose products or services are discussed in this paper.

Figures

Figure 1.
Figure 1.
Adult vent (20 Fr) with tip removed to decrease resistance and increase flow.
Figure 2.
Figure 2.
Low-flow approach. Run-through cardioplegia system with crystalloid cardioplegia clamped off and recirculation line to reservoir open.
Figure 3.
Figure 3.
High-flow approach. PA perfusion delivered through separate ¼-in line off recirculation to reservoir. Recirculation line clamped distal to Y to PA.
See this image and copyright information in PMC

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