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Beating Heart DeBakey VAD Implantation - the Muenster Technique

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.

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Beating Heart DeBakey VAD Implantation - the Muenster Technique

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  1. 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

  2. “Beating Heart” - Implantation • Sternotomy & device pocket • CPB (PFO exclusion or repair) • connection to apex • Device & driveline placement • Aortic anastomosis • De-Airing • Weaning & chest closure

  3. Sternotomy & Device Pocket • Sternotomy • Rectus sheath preparation • M. transversus dissection • Xiphoid resection

  4. Diaphragm Dissection • Pericardial incision • Enbloc-incision of diaphragm & pericardium(2 x GIA 75mm) • Re-adaptation of diaphragm & M. transversus(Vicryl-sutures)

  5. Cannulation, PFO Exploration • Aortic cannulation • Digital exploration of the atrial septum via the venous pursestring suture • PFO closure if mandatory • CPB initiation

  6. 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

  7. Apex Anastomosis II • Apical incision • Excision of the LV apex -> coring device • Removal of additional tissue / thrombus from the LV apex

  8. Apex Anastomosis III • 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

  9. Device Placement & Outflow Wrapping • Tension free device positioning (pocket size !) • Graft protector wrapping with a 22 mm PTFE prosthesis • De-airing via a large vent

  10. Driveline Tunneling • Skin incision in the lower right quadrant • Preparation of a subcutaneous tunnel using a sponge forceps for trocar protection

  11. 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)

  12. Weaning from CBP & Outflow graft wrapping II • Weaning • Wrapping of distal outflow graft with remainder of PTFE prosthesis • Drainage and chest closure as usual

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