Improved Approach With Subcostal Exchange of the HeartMate II Left Ventricular Assist Device: Difference in On and Off Pump? Ann C. Gaffey, MD, MTR,

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Presentation transcript:

Improved Approach With Subcostal Exchange of the HeartMate II Left Ventricular Assist Device: Difference in On and Off Pump? Ann C. Gaffey, MD, MTR, Carol W. Chen, MD, Jennifer J. Chung, MD, Emily Phillips, BA, Joyce Wald, DO, Matthew L. Williams, MD, David W. Low, MD, Michael A. Acker, MD, Pavan Atluri, MD The Annals of Thoracic Surgery Volume 104, Issue 5, Pages 1540-1546 (November 2017) DOI: 10.1016/j.athoracsur.2017.04.047 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The pump is exposed through a left subcostal incision. A self-retaining Rultract retractor (Rultract Inc, Inc, Cleveland, OH) is used to provide adequate exposure to the HeartMate II (St. Jude Medical, Inc, St. Paul, MN) left ventricular assist device, inflow, and outflow. The Annals of Thoracic Surgery 2017 104, 1540-1546DOI: (10.1016/j.athoracsur.2017.04.047) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Subcostal tissue and ribs are retracted with a Rultract retractor (Rultract Inc, Inc, Cleveland, OH). The new HeartMate II (St. Jude Medical, Inc, St. Paul, MN) left ventricular assist device is in the forefront, and a vascular clamp is on the outflow cannula of the old HeartMate II pump. The Annals of Thoracic Surgery 2017 104, 1540-1546DOI: (10.1016/j.athoracsur.2017.04.047) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The old HeartMate II (St. Jude Medical, Inc, St. Paul, MN) left ventricular assist device is removed. A vascular clamp on the outflow cannula and the surgeon’s thumb on the inflow cannula achieve hemostasis. The Annals of Thoracic Surgery 2017 104, 1540-1546DOI: (10.1016/j.athoracsur.2017.04.047) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The outflow graft is connected to the new ventricular assist device. The Annals of Thoracic Surgery 2017 104, 1540-1546DOI: (10.1016/j.athoracsur.2017.04.047) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The new HeartMate II (St. Jude Medical, Inc, St. Paul, MN) left ventricular assist device is in place after connection of the inflow to the HeartMate II device. The Annals of Thoracic Surgery 2017 104, 1540-1546DOI: (10.1016/j.athoracsur.2017.04.047) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Kaplan-Meier survival curves for patients undergoing HeartMate II (St. Jude Medical, Inc, St. Paul, MN) left ventricular assist device exchange through a sternotomy, on cardiopulmonary bypass (CPB) subcostal exchange (SC), and off cardiopulmonary bypass subcostal exchange. The Annals of Thoracic Surgery 2017 104, 1540-1546DOI: (10.1016/j.athoracsur.2017.04.047) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions