LVAD Explantation Using a Double-Patch Technique

Background: Clinical data on patients after left ventricular assist device (LVAD) explantation are scarce. There are several surgical approaches for explantation of an LVAD after recovery of cardiac function. Thus, remaining ventricular assist device components bear significant risks of infection or thrombosis. We hereby report our technique and two-center experience with explantation of LVADs using a double patch technique.

Method: From March 2019 to April 2021, five patients underwent LVAD explantation after myocardial recovery (HVAD, n = 2; HeartMate 3, n = 3). Mean patient age was 50.3 years (100% male) and mean time on LVAD was 23.1 ± 20.8 months. Primary heart failure etiology was dilated cardiomyopathy (n = 4) and myocarditis (n = 1).

LVAD explantation was performed using a median sternotomy and cardiopulmonary bypass. The LVAD was stopped, and the outflow graft clamped. The outflow graft was ligated and sutured close to the aortic anastomosis. The driveline was clipped and removed. Under induced fibrillation, the attachment of the LVAD was released from the apical cuff and the LVAD was removed. A round pericardial patch was fixed from the inner of the ventricle with twelve 3–0 Prolene sutures stitched from the ventricle toward the suture ring of the LVAD. This already seals the apex of the heart. An additional Gore-Tex patch is continuously sutured epicardially over the suture ring. The ventricle is carefully deflated. The patient is then weaned from ECC.

Results: The five cases showed technically uncomplicated explantation of the LVADs. During the follow-up of mean 16.4 ± 16.9 months, survival of 100% was observed. There were no bleeding complications or thromboembolic events during follow-up. This technique allowed discontinuation of anticoagulation in all patients.

Conclusion: LVAD explantation with the double-patch technique is feasible and safe. This technique allows discontinuation of anticoagulation. We have had no bleeding or thromboembolic events. Overall, there was a 30-day survival of 100%. Further studies are needed to provide better evidence for LVAD explantation and long-term follow-up.

Publication History

Article published online:
28 January 2023