title: Left Ventricular Assist Device End-to-End Connection to the Left Subclavian Artery: An Alternative Technique.
abstract: We describe a modified implantation technique for the HeartWare ventricular assist device. We access the apex through a left minithoracotomy. The outflow graft is tunneled through a small incision in the fourth intercostal space and then subcutaneously to the subclavian region. After division of the left axillary artery, an end-to-end anastomosis is performed to the proximal part, and the distal vessel is connected end-to-side through a fenestration in the outflow graft. We believe that this technique, particularly suitable for redo scenarios or severely calcified aorta, achieves a more direct blood flow into the aorta and reduces cerebrovascular events while avoiding excessive flow to the arm.
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bortolussi
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Alban
authors.initials: A
authors.lastname: Lika
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Jonida
authors.initials: J
authors.lastname: Bejko
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallo
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. Electronic address: tbottio@gmail.com.
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
mesh_terms: D000714:Anastomosis, Surgical; D001366:Axillary Artery / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017023:Coronary Angiography; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D013348:Subclavian Artery / Q000601:surgery*; D013908:Thoracotomy