• Heinrich Schima, Philipp Zrunek, Martin Stoiber, Jeff Larose, Charles Shambaugh, Dan Tamez, Zeno Deckert, Roberto Plasenzotti, Helga Bergmeister, and Georg Wieselthaler.
• Center for Medical Physics and Biomedical Engineering; Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria; Ludwig-Boltzmann-Cluster for Cardiovascular Research, Vienna, Austria. Electronic address: heinrich.schima@meduniwien.ac.at.
• J. Heart Lung Transplant. 2014 Apr 1; 33 (4): 422-8.

BackgroundMinimally invasive techniques are desirable to minimize surgical trauma during left ventricular assist device (LVAD) implantation. This is particularly challenging for full-flow support. In this study, a minimally invasive implantation technique was developed for a microaxial rotary pump. The system was evaluated in a chronic sheep model.MethodsA HeartWare MVAD (HeartWare, Miami Lakes, FL) pump (length, 50 mm; diameter, 21 mm; maximum flow, 7-8 liters/min) was combined with a novel inflow cannula, including a new flow-optimized tip. The device was implanted into sheep (range, 60-80 kg, mean, 71.6 ± 6.8 kg) through a right-sided minithoracotomy. The inflow cannula was inserted through the superior pulmonary vein, passing through the left atrium into the left ventricle. Scheduled implant period was 30 days for 8 sheep and 100 days for 3 sheep. Mean support flow was set to half of the nominal cardiac output.ResultsSix of 8 sheep finished the scheduled 30-day investigation period (one failed due to early non-pump-related post-operative bleeding and one due to prototype controller failure). The 3 sheep scheduled for 100 days reached the study end point. Peak pump flows of up to 6.9 liters/min were achieved. At necropsy, no signs of mitral valve lesions or thrombus formation around the cannula, the tip, or the insertion site were observed, except for valve leaflet erosion in 1 animal, where the cannula had been entangled in the sub-valvular chords due to lack of ultrasound monitoring.ConclusionsThe minimally invasive implantation technique using the HeartWare MVAD pump, together with a new cannula, provided excellent results in a chronic animal model.© 2013 International Society for Heart and Lung Transplantation Published by International Society for the Heart and Lung Transplantation All rights reserved.

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