Alternative Right Ventricular Assist Device Implantation Technique for Patients with Perioperative Right Ventricular Failure

The authors describe an alternative technique for insertion of a temporary RVAD so as to allow minimally invasive removal  without sternotomy after RV recovery.  An elongated graft is sewn to the PA and exited in the subxyphoid area at a site that is separate from the sternotomy incision.  After exiting, the graft is attached to an outflow cannula.  Inflow from the RA is accessed via a long cannula inserted percutaneously in the femoral vein.  At the time of RVAD removal, the graft is exposed in the subxyphoid space, where it is transected, ligated, and returned to the chest.  The femoral cannula is removed from the groin and pressue held at its entry site until hemostasis is achieved.

Innovative ways of allowing removal of a temporary RVAD without the need for sternotomy are of great value.  Surgeons should have these tools in their armamentarium.  Importantly, there are percutaneous RVADs on the horizon that may ultimately allow RVAD removal without necessarily a return trip to the OR.  Innovation and technology are playing a central role in rendering MCS surgery less invasive and therefore safer.