Surgical Insertion of a Ventricular Assist Device

Abstract

Implantable left ventricular assist devices (LVADs) have been employed throughout the world in tens of thousands of patients to assist in failing left ventricles. Device indications have been used as a “bridge” to cardiac transplantation, a “bridge” to recovery of left ventricular function, and as “destination” therapy when there are no other options. These devices have been inserted in acutely ill and decompensated hospitalized patients and in a more elective fashion in chronic heart failure as an elective admission. The basic concept of the implantable LVAD is the drawing of blood from the left ventricle into a mechanical pump, via axial or centrifugal flow, and propulsion into the ascending aorta and thus to the entire arterial system. This systemic perfusion requires a preserved right ventricular function to work effectively. This chapter reviews the operative approach and insertion techniques of durable LVADs.