Rapid pacing for the off-pump insertion of the Jarvik left ventricular assist device

We present our technique for the implantation of the Jarvik 2000 left ventricular assist device (Jarvik Heart, Inc, New York, NY) without cardiopulmonary bypass by the induction of rapid pacing that allows the insertion of the apical device into the left ventricle, minimizing blood loss and surgical complications. Although the off-pump implantation of left ventricular assist devices is not new, our experience of rapid pacing has not been previously reported to our knowledge.     

Left ventricular decompression during peripheral extracorporeal membrane oxygenation support with the use of the novel iVAC pulsatile paracorporeal assist device

Extracorporeal membrane oxygenation (ECMO) has become a widely accepted short-term mechanical circulatory support device in patients with refractory cardiogenic shock. A major drawback of the peripheral venoarterial extracorporeal membrane oxygenation is that in patients with profoundly reduced left ventricular contractility associated with high left-heart filling pressure, there is always concern for venting the failing ventricle. We describe a minimally invasive technique for decompressing the left ventricle in this setting using a novel pulsatile paracorporeal assist device, the iVAC 3L (PulseCath, Groningen, The Netherlands). It is implanted through the right axillary artery and provides hemodynamic support while directly off-loading the left ventricle.     

Implantable ventricular assist device exchange with focused intravascular deairing techniques

As ventricular assist devices are increasingly adopted and widely implemented as a highly effective therapy for end-stage heart disease, extended utilization periods for destination therapy or bridge-to-transplantation have created the possibility of device failure, infection, or thrombosis, requiring challenging implant exchanges. A major problem in these operations is the risk of air embolization, particularly in a nonsternotomy approach that precludes access to the outflow aortic graft and to the ascending aorta. We report a minimally invasive, nonsternotomy HeartMate II implantable left ventricular assist device (LVAD) exchange, using peripheral cardiopulmonary support and a novel approach to continuous intravascular ascending aortic air removal.     

Successful intraventricular thrombolysis during ventricular assist device support

Different types of mechanical ventricular assist devices are available for treating end stage congestive heart failure. Despite technical improvements, however, various complications are still reported for patients during mechanical support. We report our experience with intraventricular thrombolysis as a treatment for possible thrombosis of a continuous flow device that had been implanted as a bridge to heart transplantation. This approach has been demonstrated to be both effective and safe.     

Technique for insertion of HeartMate II left ventricular assist device inflow cannula

During implantation of the HeartMate II left ventricular assist device, the inflow cannula is typically inserted in such a way that the sewing ring is placed within the ventricular cavity in contact with the endocardium. We describe a novel implantation technique in which the sewing ring is secured to the left ventricular epicardium, thus avoiding the complication of bleeding from the exposed cut surface of apical myocardium. In addition, the shortened intraventricular segment of the inflow cannula protects against inflow occlusion by the interventricular septum.     

Left ventricular rupture during off-pump coronary artery bypass grafting

Left ventricular rupture is a highly lethal, but rare, complication of myocardial infarction. We report the first case of a postinfarction, intraoperative left ventricular apical rupture during an off-pump coronary artery bypass grafting due to the application of apical suction used to expose target vessels.     

Off-pump implantation of the HeartWare HVAD left ventricular assist device through minimally invasive incisions

Implantation of left ventricular assist devices through small incisions, avoiding cardiopulmonary bypass, may decrease the activation of the inflammatory and coagulation cascades and decrease bleeding and vasoplegia. One patient with severe, inotrope-dependant cardiomyopathy received the HeartWare left ventricular assist device (HeartWare Inc, Framingham, MA) through an upper ministernotomy and left minithoracotomy. The outflow graft was connected to the ascending aorta, and the inflow of the left ventricular assist device was attached through to the apex of the heart. The apical puncture was performed under rapid ventricular pacing, followed by insertion of the inflow of the pump. The patient was extubated rapidly and discharged home 14 days later.     

Concomitant left ventricular assist device placement and cryoablation for treatment of ventricular tachyarrhythmias associated with heart failure

Refractory ventricular tachyarrythmias (VTs) are potentially life-threatening rhythms in patients with cardiomyopathies, particularly when they result in hemodynamic instability. Here we report two cases of patients with intractable ventricular tachyarrythmias that were unresponsive to anti-arrhythmic medications and repeated catheter ablation, and for whom concomitant cryoablation and left ventricular assist device implantation was successfully performed. Both patients tolerated the procedure well with no complications and were free from ventricular tachyarrythmias postoperatively. Concomitant surgical ventricular ablation at the time of left ventricular assist device surgery may be a reasonable approach for this subset of patients as it provides excellent visualization and the ability to ablate both epicardial and endocardial sites.