Continuous-flow left ventricular assist device implantation in the presence of a hostile ventricular apex

Abstract

Management of a patient with a hostile ventricular apex at the time of continuous flow left ventricular assist device (LVAD) implantation is a challenging problem. Patients with ventricular apical aneurysm, calcified left ventricular apex, large mural thrombus burden, or massive apical myocardial infarction with friable myocardium may be unsuited to traditional LVAD implant techniques. The survival of these patients relies on the implantation of the LVAD with good inflow cannula positioning in the left ventricle. We describe a novel implant technique for a HeartMate II LVAD (Thoratec Corp, Pleasanton, Calif) in a patient with a heavily calcified left ventricular apex.