A technique for implantation of the CentriMag left ventricular assist device to allow ambulation and rehabilitation in patients with heart failure

Abstract

Background: The therapeutic options for heart failure include inotropic agents, intraaortic balloon pumps, and left ventricular assist devices (LVAD). Implantable LVADs are not appropriate for all patients. The short-term devices require patients to stay in bed, connected to cannulas, which are usually inserted using a median sternotomy. This approach requires a subsequent sternotomy, midline cannulas (which can make sitting difficult), and immobility. We began using a right thoracotomy with cannulas placed through intercostal spaces for selected patients in need of temporary LVAD support. Methods: This retrospective chart review examined our experience with CentriMag LVAD placement via right thoracotomy from August 2009 to June 2013. We reviewed the reasons for support, the degree of postoperative mobilization, and the outcomes of the patients treated in this manner. Results: This approach was used in 6 patients. Four patients lacked financial or social support for a long-term, implantable LVAD. One patient was considered too ill to have an implantable LVAD placed, and one was treated with temporary support with hope for recovery from myocarditis. Five of these 6 patients were able to walk soon after LVAD implantation and initiate rehabilitation. One did not recover and had support withdrawn. Another suffered a stroke and had support withdrawn. Four of the 6 were transplanted successfully. Conclusions: CentriMag LVAD implantation via a right thoracotomy is a feasible approach that provides adequate hemodynamic support while allowing patients to ambulate, making subsequent cardiac transplantation less complicated by allowing the avoidance of a repeat sternotomy.