Abstract
Left ventricular assist devices (LVADs) are increasingly used for the treatment of end-stage congestive heart failure, both as a bridge to transplantation and as destination therapy (1). The HeartWare HVAD (HeartWare Inc, Framingham, MA, USA) is a continuous centrifugal-flow left ventricular assist device with a magnetic levitating rotor pump. The pump weighs just 140 g and its small design allows for intra-pericardial placement. It is powered by two portable batteries that connect to the pump via a driveline tunneled through the abdominal wall, and these can be worn on a belt, allowing out of hospital support (2). The HVAD is currently indicated for use in patients with refractory end stage congestive heart failure. We outline two techniques for implanting the HeartWare HVAD: via a full median sternotomy, and using minimal access incision (Video 1). Video 1 Implantation of the HeartWare HVAD: from full sternotomy to less invasive techniques. Case 1 Clinical vignette A 56-year-old man with refractory shock due to end-stage dilated cardiomyopathy was transferred to our institution. He was initially placed on peripheral veno-arterial Extra-Corporeal Membrane Oxygenator (ECMO), as a bridge to decision, and then underwent implantation of a HeartWare HVAD as a bridge to transplantation. After three months of HVAD support, he underwent successful heart transplantation.
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