title: Operative strategies to reduce complications in Novacor left ventricular assist device placement.
abstract: BACKGROUND
  The original Novacor left ventricular assist device (LVAD) implant procedure has been extensively modified since its introduction. Our goal is to describe, in a concise and comprehensive fashion, the status of this evolution as we currently employ it at our institution. We will also investigate the possible impact of the adoption of this current methodology on the incidence of perioperative hemorrhage at our institution.
  
  
  METHODS
  The number of units of blood transfused on the day of implant surgery and the incidence of reexploration for postoperative hemorrhage were compared between the early group of consecutive patients implanted before adoption of the described implant strategy (n = 10) and the late group of consecutive patients implanted after uniform implementation of this methodology (n = 20).
  
  
  RESULTS
  Operative and immediate postoperative hemorrhage, as demonstrated by the number of blood transfusions on the day of implant surgery, was significantly reduced in the group of consecutive patients implanted after adoption of these techniques when compared to the group of patients implanted prior to technical modification.
  
  
  CONCLUSIONS
  The currently utilized Novacor LVAD implant procedure is described in detail. The amount of blood transfused on the implant day has significantly decreased since the uniform adoption of the current procedure, suggesting that the degree of perioperative hemorrhage has been favorably affected. Although implantation complications can be surgeon, device, institution and patient-specific, the strategies employed in the current implant procedure may be helpful at other heart failure centers.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA. pasquem@msnotes.wustl.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Pasque
authors.forename: Tina
authors.initials: T
authors.lastname: Hanselman
authors.forename: Kim
authors.initials: K
authors.lastname: Shelton
authors.forename: Robyn
authors.initials: R
authors.lastname: Hedges
authors.forename: Beth
authors.initials: B
authors.lastname: Keohe-Huck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012086:Reoperation; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*