Thrombosis of left ventricular assist device (LVAD) pumps is a serious complication that often requires exchange of the device. A 66-year-old man with severe peripheral vascular disease presented with pump thrombosis of the HeartMate II (HMII) LVAD 1.5 years after implantation. The HMII was exchanged to another HMII through a subcostal incision and without the use of cardiopulmonary bypass. For safety, the patient was prepared for cardiopulmonary bypass by exposing the right subclavian artery and insertion of a 5 FR cannula in the left common femoral vein. The pump was exchanged through a subcostal incision made over the LVAD pump pocket perpendicular to the costal margin. After deairing the pump and graft, LVAD support was resumed, postoperative course was uneventful, and the patient was discharged from the hospital four days later. Re-thrombosis, stroke, and right heart failure are frequent complications after LVAD exchange. Exchange through a subcostal incision with cardiopulmonary bypass backup appears to be safe.
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Akay, Mehmet H.; Salas De Armas, Ismael A.; Patel, Manish K.; Radovancevic, Rajko; and Gregoric, Igor D.
"Off-pump HeartMate II Exchange in a Patient with Severe Lower Extremity Peripheral Artery Disease: A Case Report,"
The VAD Journal: Vol. 7(1)
Available at: https://digitalcommons.library.tmc.edu/vad/vol7/iss1/7