Table 1
Criteria for left ventricular assist device explantation. RPM: rotations per minute; LPM: liters per minute; PI: pulsatility index; LVEF: left ventricular ejection fraction; LVEDD: left ventricular end-diastolic diameter; MR: mitral regurgitation; AV: aortic valve; PA: pulmonary artery; PCWP: pulmonary capillary wedge pressure; CO: cardiac output; CI: cardiac index; Sat: saturation
| RPM | FLOW (LPM) | POWER (WATTS) | PI | LV EF | LV EDD | MR SEVERITY | AV | PA (MM HG) | PCWP (MM HG) | CO/CI (L/MIN/M2) | PA SAT |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 5500 | 4 | 6.7 | 4.5 | 40–50% | 4.6 | mild | opens | 29/11 | 9 | 6.2/2.8 | 71% |
| 5000 | 2.8 | 4.4 | 6.5 | 40–50% | 4.7 | mild | opens | 29/9 | 12 | 5.8/2.6 | 70% |
| 4500 | 0.9 | 2.9 | 10 | 40–50% | 4.7 | mild | opens | 32/16 | 13 | 5.7/2.6 | 67% |
| 4000 | 1.5 | 2.9 | 8.8 | 40–50% | 4.7 | mild | opens | 63/27 | 23 | 13/5.9 | 67% |
Figure 1
Felt Dacron plug creation. (A) Rolled PTFE felt placed within 20-mm Hemashield graft. (B) 20-mm circular pericardial patch was sewn onto one end of the graft. (C) 1.5-mm PTFE felt ring with 20-mm central circular opening was sewn to the tubular graft, 1 cm away from the pericardial patch end. A second identical felt ring was attached to the first ring using bio-glue as a sealant. PTFE: polytetrafluoroethylene
Figure 2
Implanted custom-made skirted synthetic plug. (A) HeartMate3 pump, bend relief and driveline exposed. (B) While on cardiopulmonary bypass, device turned off, outflow graft stapled, driveline cut, and pump removed. (C, D) Custom-made skirted synthetic plug inserted into the ventricular core and fixed onto the sewing ring.
Figure 3
Pre- and postoperative computed tomography scans. Residual left ventricular assist device fixation ring present with hemostatic synthetic plug and notable absence of left ventricular thrombus.