How I Do It: Temporary RVAD Placed at the Time of Implantation of a HeartMate II LVAD

Abstract

Left ventricular assist devices (LVAD) are increasingly used to support patients as they await heart transplantation and as destination therapy for patients with end-stage cardiac failure. While the methods of LVAD implantation have become fairly standardized, early postoperative management of patients receiving these devices remains challenging. One issue that has plagued surgeons, cardiologists, and intensivists caring for patients after LVAD implantation is right heart dysfunction. While many scoring systems have been developed to try to anticipate RV failure, the accuracy of these predictive tools remains low. We present a novel approach of implantation of a temporary right ventricular assist devices (RVAD) during LVAD implantation with subsequent weaning in the immediate postoperative period, utilizing a strategy that does not require a return to the operating room for removal of the RVAD cannulas.