title: An alternative approach to explantation and exchange of the HeartWare left ventricular assist device.
abstract: OBJECTIVE
  Left ventricular assist device (LVAD) explantation and exchange is a relatively infrequent but potentially complex procedure. Patients requiring such procedures have multisystem suboptimal physiological reserve due to end-stage heart failure and are prone to complications. Less-invasive procedures are believed to facilitate postoperative recovery and early mobilization. We describe an alternative approach to explantation and exchange of the HeartWare LVAD through left thoracotomy.
  
  
  METHODS
  Six patients (M = 4, F = 2, mean age = 49.16 years) underwent device explant/exchange or initial implant (explant = 2, exchange = 3, initial implant = 1) through left thoracotomy utilizing cardiopulmonary bypass and induced ventricular fibrillation (VF). The mean bypass time and mean VF arrest time were 82 and 3 min, respectively. A new outflow graft was anastomosed to the previous outflow graft in 3 cases of device exchange and to the descending aorta in 1 case of initial implant.
  
  
  RESULTS
  One patient died in the intensive care unit due to unrelated causes (gram-negative sepsis) after device exchange. All others were discharged alive and currently remain on follow-up. The mean length of hospital stay was 40.66 days.
  
  
  CONCLUSIONS
  On-pump approach through single thoracotomy incision is safe and equally suitable for device explant, exchange and initial implant. However, structural heart defects requiring surgical correction and the requirement of simultaneous right ventricular assist device are the limitations of this approach.
authors.affiliation: Mechanical Circulatory Support Program, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK. jsyousafzai@hotmail.com
authors.forename: Mohammad
authors.initials: M
authors.lastname: Sajjad
authors.forename: Tanveer
authors.initials: T
authors.lastname: Butt
authors.forename: Faruk
authors.initials: F
authors.lastname: Oezalp
authors.forename: Aleem
authors.initials: A
authors.lastname: Siddique
authors.forename: Neil
authors.initials: N
authors.lastname: Wrightson
authors.forename: David
authors.initials: D
authors.lastname: Crawford
authors.forename: Thasee
authors.initials: T
authors.lastname: Pillay
authors.forename: Stephan
authors.initials: S
authors.lastname: Schueler
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D020878:Device Removal / Q000379:methods*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D013908:Thoracotomy / Q000379:methods*; D014693:Ventricular Fibrillation