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Ann Thorac Surg 2007;84:301-302
© 2007 The Society of Thoracic Surgeons

How To Do It

Reinforcement of Left Ventricular Assist Device Outflow Grafts to Prevent Kinking

William E. Cohn, MDa,b,*, Igor D. Gregoric, MDa, O.H. Frazier, MDa,b

a Center for Cardiac Support, Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas
b Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

Accepted for publication October 3, 2006.

* Address correspondence to Dr Cohn, Texas Heart Institute at St. Luke’s Episcopal Hospital, PO Box 20345, MC 2-114A, Houston, TX 77225-0345 (Email: wcohn{at}heart.thi.tmc.edu).

Because of their small size, rotary left ventricular assist devices (LVADs) can be implanted through several alternative approaches, including transdiaphragmatic LVAD insertion through a left subcostal incision with anastomosis of the outflow graft to the retroperitoneal supra-celiac aorta and a left thoracotomy approach with anastomosis to the descending thoracic aorta. More recently we have added a counter-incision to allow the outflow graft of a transdiaphragmatic LVAD to be tunneled through the right chest and anastomosed to the ascending aorta. However, constructing a tension-free, nonkinking lie of the outflow graft can be challenging. We have found that placing a 10-cm to 15-cm length of polytetrafluoroethylene graft coaxially over the LVAD outflow graft ensures a smooth, kink-free lie. Thus far 12 patients have undergone reinforcement of the LVAD outflow graft prior to graft-to-aorta anastomosis. In all cases, graft lie was facilitated and kinking was eliminated.






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Copyright © 2007 by The Society of Thoracic Surgeons.