Novel Modification of HeartMate 3 Implantation

We have modified the HeartMate 3 (Abbott, Abbott Park, IL) implantation technique to better suit our patient population. This modification optimizes placement of sewing cuff and allows passage suture transmurally from endocardium epicardium in a “cut then sew” technique. believe this affords superior seal protection tearing friable myocardium. The left ventricular assist device (LVAD) system has become an effective popular LVAD, both nationally at institution. standard recommended by manufacturer uses horizontal mattress sutures passed continuous felt strip or through large pledget into myocardium ring “sew cut” method.1Netuka I. technique: devil is detail.Interact Cardiovasc Thorac Surg. 2018; 27: 946-949PubMed Google Scholar,2Beyersdorf F. Scheumann J. Siepe M. Implantation 3—description surgical technique.Oper Tech 2017; 22: 173-185Abstract Full Text PDF Scopus (3) Scholar After secured, coring used remove core allow for inflow cannula. Other modifications exist apical implantation. report details method using endocardial-to-epicardial placement. was developed institution with excellent outcomes. While not meant replace other methods implantation, we found it particularly useful patients thin, heart exposed median sternotomy. first tunnel driveline before any heparin administered. systemically heparinized cannulated bypass ascending aortic right atrial cannulas. Cardiopulmonary initiated, (LV) apex elevated field laparotomy sponges packed pericardium. LV cannula position are determined digital palpation transesophageal echocardiography guidance. make incision 11 blade scalpel. A Coude Foley catheter placed incision, advanced over previously direction position. removed sent pathology. Trabeculations that may obstruct excised. Using 2-0 Ethibond (Ethicon, Somerville, NJ) on SH-2 needle loaded 0.375-inch × 0.1875-inch 0.0625-inch pledgets, place 12 (or as many necessary) interrupted passing epicardium. do use hand-cut pledgets prevent overcrowding within cavity. Once all place, these tied down. brought onto connected ring. vent outflow air connect graft. graft anastomosis constructed fashion. can also be if “outflow first” technique, performing initiating cardiopulmonary bypass. safe effective. Because improved visualization more direct path epicardium, delicate, apices. In experience, straight distribution force intraventricular acts epicardial side and, combination distributes tension evenly injury. Criticism could potential loss, malfunction, thrombus formation. implanted than 100 LVADs which 10 those gone transplant. At time recipient cardiectomy, evaluated native endothelialization. well incorporated (1Netuka Scholar, 2).Figure 2Endocardium expose well-incorporated pledgets.View Large Image Figure ViewerDownload Hi-res image Download (PPT) had no pledget-related complications successfully navigated myriad anatomy. others, but instead, offer alternative discretion implanting surgeon circumstances dictate. further study will help delineate risk pump thrombosis, panus ingrowth.