Beating Heart DeBakey VAD Implantation -

the Muenster Technique

Dieter Hammel, Christof Schmidt*, Christof Schmid, Markus J. Wilhelm, Mario C. Deng & Hans H. Scheld

Depts. of Cardiothoracic Surgery & Anesthesiology*

Westfalian Wilhelms-University of Muenster

Muenster, Germany

“Beating Heart” - Implantation

• Sternotomy & device pocket• CPB (PFO exclusion or repair)• connection to apex• Device & driveline placement• Aortic anastomosis• De-Airing• Weaning & chest closure

Sternotomy & Device Pocket

• Sternotomy• Rectus sheath

preparation• M. transversus

dissection• Xiphoid resection

Diaphragm Dissection

• Pericardial incision• Enbloc-incision of

diaphragm & pericardium(2 x GIA 75mm)

• Re-adaptation of diaphragm & M. transversus(Vicryl-sutures)

Cannulation, PFO Exploration

• Aortic cannulation

• Digital exploration of the atrial septum via the venous pursestring suture

• PFO closure if mandatory

• CPB initiation

Apex Anastomosis I

• LV apex elevation

• 8 Ethibond (3-0 MH) sutures with 2 teflon felt strips (circular)

• 4 of 8 knots of apical fixation ring

• Apical incision

• Excision of the LV apex -> coring device

• Removal of additional tissue / thrombus from the LV apex

Apex Anastomosis II

• Inflow cannula insertion

• Suturing of inflow cannula suture ring to the apical fixation ring (Ethibond)

• Final running suture (3-0 Prolene) between felt strips and inflow cannula suture ring

Apex Anastomosis III

• Tension free device positioning (pocket size !)

• Graft protector wrapping with a 22 mm PTFE prosthesis

• De-airing via a large vent

Device Placement & Outflow Wrapping

• Skin incision in the lower right quadrant

• Preparation of a subcutaneous tunnel using a sponge forceps for trocar protection

Driveline Tunneling

Aortic Anastomosis

• Measuring of the outflow graft length

• End-to-side anastomosis (4-0 Prolene, delayed tying for adequate deairing)

• CVP by CBP & pump start (start NO inhalation)

Weaning from CBP & Outflow graft wrapping II

• Weaning• Wrapping of

distal outflow graft with remainder of PTFE prosthesis

• Drainage and chest closure as usual