Total ventricular assist for long-term treatment of heart failure

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Total ventricular assist for long-term treatment of heart failure Antonis A. Pitsis, MD, FETCS, FESC, Aikaterini N. Visouli, MD, Vlasis Ninios, MD, MRCP, Dimitrios T. Kremastinos, MD, FESC The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 2, Pages 464-467 (August 2011) DOI: 10.1016/j.jtcvs.2010.11.014 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Total ventricular assist with 2 Jarvik 2000 continuous axial flow intraventricular pumps first applied on March 25, 2009. Elective single-stage, off-pump, beating-heart (without ventricular fibrillation) implantation of 2 pumps through a left thoracotomy, which provided good access to the left ventricular apex and to the diaphragmatic surface of the right ventricle close to the acute margin and the RV apex without major cardiac distortion, facilitating implantation without hemodynamic compromise is shown. Furthermore, it was advantageous in the first patient who had undergone a median sternotomy and had patent, skeletonized bilateral internal thoracic artery grafts beneath the sternum. After feasibility of implantation and good exposure was shown in the first patient, the same implantation method was adapted in the second patient. A, Head–neck and chest radiographs of the first patient. One tunnel was created for both power cables, and 2 pedestals were screwed to the left postauricular and supra-auricular area of the skull. LP, Left pedestal; RP, right pedestal; RVAD pump, right ventricular assist device pump (inside the right ventricle); LVAD pump, left ventricular assist device pump (inside the left ventricle). B, Schematic representation of implantation of 2 Jarvik 2000 pumps for total ventricular assist. Left ventricular assist device pump inflow is “facing” the mitral valve. Right ventricular assist device pump inflow is “facing” the pulmonary valve. The left ventricular assist device outflow graft was anastomosed to the descending thoracic aorta. The right ventricular assist device outflow graft was anastomosed to the left pulmonary artery. C, Photograph of the first patient on the 42nd day of support. LP, Left pedestal; RP, right pedestal. The left ventricular assist device pedestal was fixed at a high point of the left postauricular area, and the right ventricular assist device pedestal was fixed superiorly and posteriorly to it. The pedestal fixation areas need not be strictly postauricular. At both places, the skull had sufficient thickness of greater than 8.8 mm, as measured on preoperative computed tomographic analysis. Fixation to the skull and increased area vascularity ensured excellent wound healing with minimal care. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 464-467DOI: (10.1016/j.jtcvs.2010.11.014) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions