title: Reinforcement of left ventricular assist device outflow grafts to prevent kinking.
abstract: Because of their small size, rotary left ventricular assist devices (LVADs) can be implanted through several alternative approaches, including transdiaphragmatic LVAD insertion through a left subcostal incision with anastomosis of the outflow graft to the retroperitoneal supra-celiac aorta and a left thoracotomy approach with anastomosis to the descending thoracic aorta. More recently we have added a counter-incision to allow the outflow graft of a transdiaphragmatic LVAD to be tunneled through the right chest and anastomosed to the ascending aorta. However, constructing a tension-free, nonkinking lie of the outflow graft can be challenging. We have found that placing a 10-cm to 15-cm length of polytetrafluoroethylene graft coaxially over the LVAD outflow graft ensures a smooth, kink-free lie. Thus far 12 patients have undergone reinforcement of the LVAD outflow graft prior to graft-to-aorta anastomosis. In all cases, graft lie was facilitated and kinking was eliminated.
authors.affiliation: Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA. wcohn@heart.thi.tmc.edu
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D011138:Polytetrafluoroethylene; D019919:Prosthesis Implantation / Q000379:methods*
chemical_list: D011138:Polytetrafluoroethylene