The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle
Background: The HeartMate 3 (HM3) has become among the most widely utilized durable left ventricular (LV) assist devices (LVAD) owing to reduced rates of pump thrombosis, bleeding, and stroke. One limitation of the HM3 is its large size, which poses a challenge for implantation in smaller LVs. Herei...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-05-01
|
| Series: | JHLT Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000515 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850039951058534400 |
|---|---|
| author | Ryaan EL-Andari, MD Josiane Dion, MD Jennifer Conway, MD, MSc Tara Pidborochynski, MSc Lindsey Carter, MD Gurmeet Singh, MD, MSc Roderick MacArthur, MD, MSc Steven Meyer, MD, PhD Devilliers Jonker, MD Darren H. Freed, MD, PhD Holger Buchholz, MD |
| author_facet | Ryaan EL-Andari, MD Josiane Dion, MD Jennifer Conway, MD, MSc Tara Pidborochynski, MSc Lindsey Carter, MD Gurmeet Singh, MD, MSc Roderick MacArthur, MD, MSc Steven Meyer, MD, PhD Devilliers Jonker, MD Darren H. Freed, MD, PhD Holger Buchholz, MD |
| author_sort | Ryaan EL-Andari, MD |
| collection | DOAJ |
| description | Background: The HeartMate 3 (HM3) has become among the most widely utilized durable left ventricular (LV) assist devices (LVAD) owing to reduced rates of pump thrombosis, bleeding, and stroke. One limitation of the HM3 is its large size, which poses a challenge for implantation in smaller LVs. Herein, we describe a novel technique for durable LVAD implantation in patients with a small LV. Methods: Patients who underwent durable LVAD implantation from January 2020 to August 2024 were included in this study. The modified technique involved excision of the mitral valve (MV) and associated apparatus to create room for the LVAD inflow. The primary outcome was mortality, and secondary outcomes included rates of postoperative complications and hemodynamic parameters. Patient follow-up was until September 2024. Results: Eleven patients were included in this study. All patients received an HM3. The median preoperative LV end-diastolic diameter was 5.1 cm. The median total time on LVAD was 149 days, and overall mortality was 27.2% occurring a median of 204 days post-LVAD implantation. Four patients (36.4%) underwent heart transplantation and 4 (36.4%) were alive on LVAD at last follow-up. Proportions of morbidity included readmission for heart failure (n = 2, 18.2%), cerebrovascular accident (n = 2, 18.2%), and pump thrombosis (n = 0). Conclusions: The small LV has been a significant challenge for durable LVAD insertion and is often considered a contraindication. A modified approach to LVAD insertion, including excision of the MV and associated apparatus and alignment of the LVAD inflow cannula with the MV orifice, allows for LVAD implantation in patients with a small LV. |
| format | Article |
| id | doaj-art-c90c8b9eb29d41c9a8fd71854f1ac2a9 |
| institution | DOAJ |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-c90c8b9eb29d41c9a8fd71854f1ac2a92025-08-20T02:56:12ZengElsevierJHLT Open2950-13342025-05-01810025610.1016/j.jhlto.2025.100256The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricleRyaan EL-Andari, MD0Josiane Dion, MD1Jennifer Conway, MD, MSc2Tara Pidborochynski, MSc3Lindsey Carter, MD4Gurmeet Singh, MD, MSc5Roderick MacArthur, MD, MSc6Steven Meyer, MD, PhD7Devilliers Jonker, MD8Darren H. Freed, MD, PhD9Holger Buchholz, MD10Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, CanadaDepartment of Cardiology, University of Alberta, Edmonton, Alberta, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaDepartment of Cardiology, University of Alberta, Edmonton, Alberta, CanadaDivision of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, CanadaDivision of Cardiac Surgery, University of Alberta, Edmonton, Alberta, CanadaDivision of Cardiac Surgery, University of Alberta, Edmonton, Alberta, CanadaDivision of Congenital Cardiac Surgery, University of Alberta, Edmonton, Alberta, CanadaDivision of Congenital Cardiac Surgery, University of Alberta, Edmonton, Alberta, CanadaDivision of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada; Corresponding author: Holger Buchholz, MD, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.Background: The HeartMate 3 (HM3) has become among the most widely utilized durable left ventricular (LV) assist devices (LVAD) owing to reduced rates of pump thrombosis, bleeding, and stroke. One limitation of the HM3 is its large size, which poses a challenge for implantation in smaller LVs. Herein, we describe a novel technique for durable LVAD implantation in patients with a small LV. Methods: Patients who underwent durable LVAD implantation from January 2020 to August 2024 were included in this study. The modified technique involved excision of the mitral valve (MV) and associated apparatus to create room for the LVAD inflow. The primary outcome was mortality, and secondary outcomes included rates of postoperative complications and hemodynamic parameters. Patient follow-up was until September 2024. Results: Eleven patients were included in this study. All patients received an HM3. The median preoperative LV end-diastolic diameter was 5.1 cm. The median total time on LVAD was 149 days, and overall mortality was 27.2% occurring a median of 204 days post-LVAD implantation. Four patients (36.4%) underwent heart transplantation and 4 (36.4%) were alive on LVAD at last follow-up. Proportions of morbidity included readmission for heart failure (n = 2, 18.2%), cerebrovascular accident (n = 2, 18.2%), and pump thrombosis (n = 0). Conclusions: The small LV has been a significant challenge for durable LVAD insertion and is often considered a contraindication. A modified approach to LVAD insertion, including excision of the MV and associated apparatus and alignment of the LVAD inflow cannula with the MV orifice, allows for LVAD implantation in patients with a small LV.http://www.sciencedirect.com/science/article/pii/S2950133425000515ventricular assist deviceleft ventriclemitral valvemechanical circulatory supportheart failure |
| spellingShingle | Ryaan EL-Andari, MD Josiane Dion, MD Jennifer Conway, MD, MSc Tara Pidborochynski, MSc Lindsey Carter, MD Gurmeet Singh, MD, MSc Roderick MacArthur, MD, MSc Steven Meyer, MD, PhD Devilliers Jonker, MD Darren H. Freed, MD, PhD Holger Buchholz, MD The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle JHLT Open ventricular assist device left ventricle mitral valve mechanical circulatory support heart failure |
| title | The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle |
| title_full | The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle |
| title_fullStr | The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle |
| title_full_unstemmed | The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle |
| title_short | The approach to placement of a continuous-flow intracorporeal ventricular assist device in small left ventricle |
| title_sort | approach to placement of a continuous flow intracorporeal ventricular assist device in small left ventricle |
| topic | ventricular assist device left ventricle mitral valve mechanical circulatory support heart failure |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000515 |
| work_keys_str_mv | AT ryaanelandarimd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT josianedionmd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT jenniferconwaymdmsc theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT tarapidborochynskimsc theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT lindseycartermd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT gurmeetsinghmdmsc theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT roderickmacarthurmdmsc theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT stevenmeyermdphd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT devilliersjonkermd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT darrenhfreedmdphd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT holgerbuchholzmd theapproachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT ryaanelandarimd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT josianedionmd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT jenniferconwaymdmsc approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT tarapidborochynskimsc approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT lindseycartermd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT gurmeetsinghmdmsc approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT roderickmacarthurmdmsc approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT stevenmeyermdphd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT devilliersjonkermd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT darrenhfreedmdphd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle AT holgerbuchholzmd approachtoplacementofacontinuousflowintracorporealventricularassistdeviceinsmallleftventricle |