Use of miniaturized extracorporeal circulation for implanting left ventricular assist devices in high-risk end-stage heart failure patients

Abstract

Background Miniaturized extracorporeal circulation (MECC) has been implemented in clinical practice for the last decade with superior results regarding postoperative morbidity and mortality mainly in coronary procedures. We challenged this technique in high-risk patients with end-stage heart failure undergoing left ventricular assist device (LVAD) implantation. Methods Four patients with end-stage ischemic heart failure were included in this study. All patients were inotrope dependent (INTERMACS class 2) and their preoperative evaluation considered them to be high-risk for developing postoperative right ventricular failure. Hence, optimization of right ventricular function was performed preoperatively following a protocol based on intermittent administration of doses of levosimendan. Two Jarvik 2000 and two HeartWare LVADs were implanted on beating heart using MECC system. Surgical strategy included retrograde autologous priming of the circuit and avoidance of administering cardioplegia. Results