Conventional and alternative sites for left ventricular assist device inflow and outflow cannula placement

Abstract

Left ventricular assist device (LVAD) therapy is a well accepted and effective strategy to treat advanced heart failure. The miniaturized third-generation centrifugal pumps HeartWare HVAD (Medtronic, Dublin, Ireland) and HeartMate 3 (Abbott, Illinois, USA) are the two most commonly implanted systems in the contemporary era. Their design has allowed clinicians to pioneer several alternate and less invasive implantation techniques to tackle a broad spectrum of clinical scenarios. A brief review and discussion of alternative surgical techniques for both inflow and outflow cannula insertion, in the contemporary LVAD surgery era, are herein reported.

Keywords: Left ventricular assist device (LVAD); biventricular assist device (BiVAD); inflow cannula; less invasive cardiac surgery; outflow cannula.

Figure 1

Profiles of current third-generation centrifugal pumps.

Figure 2

Left ventricular assist device insertion after concomitant left ventricular aneurysm reconstruction with a synthetic patch.

Figure 3

Sewing ring placement on the inferior left ventricular wall.

Figure 4

Intrapericardial tunneling scheme of outflow graft from the left side to the ascending aorta, during less invasive sternotomy-sparing approaches.

Figure 5

Outflow graft tunneling through the transverse sinus.

Figure 6

Outflow graft anastomosis to the descending aorta.

Figure 7

Outflow graft anastomosis to the supra-celiac abdominal aorta.

Figure 8

Outflow graft anastomosis to the innominate artery.

Figure 9

Scheme of outflow graft anastomosis to the left axillary artery, during less invasive sternotomy-sparing approaches.

Figure 10

Biventricular assist device (BiVAD) setting.