Heartmate III™ Implantation: A Novel Technique to Reduce the Incidence of Perioperative Bleeding and the Use of Intraoperative Blood Products

Abstract

We describe a method for implanting the Abbot HeartMate 3™ (HM3) Left Ventricular Assist Device (LVAD) that may reduce perioperative bleeding and the use of blood products. First a median sternotomy is performed and the HM3 prepared. The driveline is tunneled through the subcutaneous tissue and the patient is placed on cardiopulmonary bypass (CPB). The HM3 is implanted via the "cut then sew" method. A ring is made from Teflon™ felt and placed over the cuff of the HM3 sewing ring (Figure 1A-C). After coring the LV apex, a second donut shaped felt ring (1D) is placed (1E). Sutures are placed through the felt and LV wall and passed through the sewing cuff. The cuff is lowered, sutures tightened (1F-G), and more sutures are placed through the cuff and passed through the myocardium and felt strip (1H). The inflow and outflow cannula are attached, and patient removed from CPB. To determine the effect of this method on perioperative bleeding, we reviewed the charts of 114 patients that underwent HM3 placement in our institution between October 2015 and June 2019 by 4 surgeons, 1 of whom used this method. Table 1 shows our results and suggests that the novel method results in less perioperative bleeding, as indicated by both comparison of pre and postoperative hemoglobin and hematocrit and the amount of blood products given intraoperatively. The novel method also resulted in a shorter procedure time, possibly due to improved hemostasis. Our addition of Teflon™ felt strips around the sewing cuff of the HM3 may reduce perioperative bleeding and the use of perioperative blood products.