Intraperitoneal pocket for left ventricular assist device placement.
BACKGROUND
Implantation of the HeartMate Implanted Pneumatic or Vented Electric Ventricular Assist Device requires that the pump be implanted either in the peritoneal cavity or in the abdominal wall. Both sites have been problematic.


METHODS
We describe a new technique in which an intraperitoneal pocket is created, using Gore-Tex Dual Mesh Plus Biomaterial with Holes, to contain the ventricular assist device. This shields the ventricular assist device from the peritoneal contents and avoids abdominal wall dissection. Thirty consecutive patients who underwent implantation using this technique were compared with 16 patients who underwent implantation before this technique was in use.


RESULTS
Thirty consecutive patients underwent implantation, and 2 of those patients underwent re-implantation because of device failure (16/30 HeartMate Implanted Pneumatic, 14/30 HeartMate Vented Electric, and 2/14 HeartMate Vented Electric replaced with the HeartMate Implanted Pneumatic). Twenty-five patients have undergone explantation. Pocket infections in patients who have had implanted devices for >1 month decreased from 4 of 13 before the pockets were used to 1 of 25 with the intraperitoneal pockets (Fisher's exact test p = 0.038). Two hernia repairs were required after explantation when the biomaterial pocket was used. A decrease in return to surgery for bleeding was noted after the pocket was used (7/16 without the pocket and 3/32 with the pocket; Fisher's exact test, p = 0.010).


CONCLUSIONS
Bleeding complications and pocket infections decreased in this early experience. Further study is necessary to confirm the apparent decrease in complication rate by using this new technique in this small cohort of patients.
Icenogle
Tim
T
Inland Northwest Thoracic Organ Transplant Program, Heart Institute of Spokane, Sacred Heart Medical Center, Spokane, Washington, USA. ticenogle@nwcardio.org
Sandler
David
D
Puhlman
Mark
M
Himley
Steve
S
Sato
David J
DJ
Schaefer
Stacy
S
D020878:Device Removal; D004867:Equipment Design / Q000295:instrumentation; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010529:Peritoneal Cavity / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome