A novel implantation technique for Korean BVAD (AnyVAD) -Korea University Technique- Using a right thoracotomy approach-

초록

PURPOSE OF THE STUDY: Although a median sternotomy has been an approach of choice in bi-ventricular assist device (BVAD), sternotomy-related morbidity and mortality remains one of the leading causes of death after device implantation. Considering most patients require a future re-sternotomy for heart transplantation or device weaning, an alternative approach can be suggested. We have applied a new technique of right thoracotomy in the development of Korean BVAD (AnyVAD). METHODS USED: During the past two years, a total of twenty animals underwent AnyVAD implantation either for BVAD or LVAD support. Of them, a right thoracotomy approach was used in twelve animals (BVAD in 10 and LVAD in 2). The chest cavity was entered through the 4th intercostal space or the 5th periosteal bed. The right side inflow cannula was inserted into the right atrial free wall and the outflow cannula was grafted onto the main pulmonary artery. The left side inflow cannula was inserted into the interatrial groove, and the outflow cannula was grafted on the innominate artery. The connecting tubes brought out through the thoracotomy wound and connected to the pump located at the subcutaneous pocket of the right flank. RESULTS OBTAINED: Except animals for a fitting test, all were survived after the procedures. The inflow drainage allowed the pump output 4.5 L/min at the maximum with 2.5 L/min in an average. There was no cannula-related outflow resistance. Autopsy findings demonstrated the well-positioned cannula tips in each cardiac chamber. CONCLUSIONS TEACHED: The Korea University technique of a right thoracotomy approach is simple, safe, and reproducible. When applied clinically, it can avoid sternotomy-related complications. In addition, when heart transplantation is performed later on, all cannulas can be removed through a median sternotomy without re-thoracotomy.

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