title: Alternative right ventricular assist device implantation technique for patients with perioperative right ventricular failure.
abstract: OBJECTIVE
  Temporary right ventricular assist devices (RVADs) may be required to support patients with perioperative refractory right ventricular failure (RVF). We report on our experience using a different technique of RVAD implantation that does not necessitate resternotomy at the time of RVAD removal.
  
  
  METHODS
  Patients with perioperative RVF who underwent temporary RVAD implantation between January 2010 and February 2014 were reviewed. A dacron graft was attached to the pulmonary artery and passed through a subxiphoid exit, where the RVAD outflow cannula was inserted. The inflow cannula was percutaneously cannulated in the femoral vein, and the sternum was primarily closed. On the day of RVAD explantation, the outflow graft of the RVAD was pulled and ligated, and the insertion site was secondarily closed. The RVAD inflow cannula was removed, and direct pressure was applied.
  
  
  RESULTS
  Twenty-one patients (age 58 ± 14 years) were supported. Seventeen patients (81%) had RVF after left ventricular assist device implantation, and 4 patients developed postcardiotomy RVF. The median duration of RVAD support was 9 days (range: 2-88 days). Eleven patients (52%) were successfully weaned from the RVAD. Two patients were bridged to transplantation. Eight patients died on left ventricular assist device and/or RVAD support. The survival rates to discharge or heart transplantation, and to 1-year, were 62% and 52%, respectively.
  
  
  CONCLUSIONS
  No technical issues were encountered in this large series of RVAD implantations using the described technique for various forms of postoperative RVF. Extended support duration and reduction of resternotomy risks may be the main advantages of this technique compared with conventional RVAD implantation methods.
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany. Electronic address: diyar.saeed@med.uni-duesseldorf.de.
authors.forename: Diyar
authors.initials: D
authors.lastname: Saeed
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Bujar
authors.initials: B
authors.lastname: Maxhera
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
authors.affiliation: Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D020878:Device Removal; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016278:Ventricular Function, Right
keywords: adult; cardiomyopathy; circulatory support devices (LVAD, RVAD, BVAD, TAH); heart failure; right ventricle