Surgical Technique for Redo-Sternotomy Sparing Heartware HVAD Exchanges

Abstract

Prolonged support times in bridge to transplant patients, as well as the growing number of destination patients lead to increased rates of LVAD pump exchanges for pump thrombosis, pump infections, and other device problems. We describe our surgical approach for pump exchanges in patients supported with the Heartware HVAD ventricular assist device. Pump exchanges are performed via a limited thoracotomy in the fourth, fifth, or sixth left intercostal space with cardiopulmonary bypass support. The apical sewing ring as well as the outflow graft are reused in order to limit the complexity of the procedure and minimize the need for extensive dissections. Given the significant reduction in surgical complexity and invasiveness, the described technique should be considered the standard approach for Heartware HVAD patients with device complications necessitating isolated pump exchanges.