LVAD DeBakey implantation

Beating Heart DeBakey VAD

Implantation

-the Muenster Technique

Dieter Hammel, Christof Schmidt*, Christof Schmid, Markus J. Wilhelm, Mario C. Deng & Hans H. Scheld

“Beating Heart” - Implantation

• Sternotomy & device pocket

• CPB (PFO exclusion or repair)

• connection to apex

• Device & driveline placement

• Aortic anastomosis

• De-Airing

Sternotomy & Device Pocket

• Sternotomy

• Rectus sheath

preparation

• M. transversus

dissection

• Xiphoid resection

Diaphragm Dissection

Cannulation, PFO Exploration

• Aortic cannulation • Digital exploration

of the atrial septum via the venous

pursestring suture • PFO closure if

mandatory

Apex Anastomosis I

• LV apex elevation

• 8 Ethibond (3-0 MH)

sutures with 2 teflon felt strips (circular)

• 4 of 8 knots of apical

• Apical incision • Excision of the LV apex -> coring device • Removal of additional tissue / thrombus from the LV apex

Apex Anastomosis II

• Inflow cannula

insertion

• Suturing of inflow

cannula suture ring to the apical fixation ring (Ethibond)

• Final running suture

(3-0 Prolene)

between felt strips and inflow cannula suture ring

• Tension free device positioning (pocket size !) • Graft protector wrapping with a 22 mm PTFE prosthesis • De-airing via a

• Skin incision in the lower right quadrant

• Preparation of a subcutaneous

tunnel using a

sponge forceps for trocar protection

Aortic Anastomosis

• CVP  by CBP &

Weaning from CBP &

Outflow graft wrapping II

• Weaning

• Wrapping of distal

outflow graft with remainder of

PTFE prosthesis

• Drainage and

chest closure as usual