Fig. 34.1
Intraoperative view of individually designed titanium plug inserted after HeartWare HVAD explantation through left lateral thoracotomy
Fig. 34.2
Thoracic X-ray after removal of HeartMate II showing the titanium plug inserted into the original fixation ring “chimney”
◘ Table 34.1 shows the advantages and disadvantages of these approaches.
Table 34.1
Advantages and disadvantages of approaches to LVAD removal
Approach | Advantage | Disadvantage | Indication |
|---|---|---|---|
1. Complete removal | No foreign material remains in the body | Redo surgery, use of CPB, risk of damage or bleeding | Infected LVAD |
2. Partial removal without plug | Less invasive approach, reduced risk of damage and bleeding | Use of CPB, outflow graft remains in the body | Non-infected LVAD, type Incor, HeartAssist5, Jarvik 2000 |
3. Partial removal of HeartMate II pump | Less invasive approach, no need for CPB, low risk of damage and bleeding | Outflow graft remains in the body. Inflow cannula remains in the cavum of the LV. Life-long anticoagulation | For HeartMate II only |
4. Partial removal employing specially designed plug | Less invasive approach, no need for CPB, minimal risk of damage and bleeding. Possible reuse of the apical ring if 2nd pump becomes necessary | Outflow graft remains in the body | Non-infected LVAD, type HeartWare HVAD and HeartMate II |
5. Ligation of the outflow graft | Minimally invasive approach, no need for CPB, minimal risk of damage and bleeding | Driveline remains in the body. Inflow cannula remains in the cavum of the LV. Life-long anticoagulation | Patients with high risk for major surgery |
6. Percutaneous interventional closure of the outflow graft [5]
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