Tentacles: A Novel Device for Exposing the Heart for the Insertion of Left Apical Assist Device Cannulae
Background: The implantation of ventricular assist devices is a well-established procedure for the treatment of imminent heart failure. The exact positioning of the left ventricular apical inflow cannula is crucial, because inflow restrictions might occur when the cannula is placed too close to the interventricular septum or a papillary muscle. We report a novel technique using the Tentacles 3-point fixation device for the exposure of the left ventricular apex during ventricular fibrillation under cardiopulmonary bypass.
Methods: We used the Tentacles, a device originally designed for positioning the heart during off-pump coronary artery bypass grafting, for implantation of a biventricular Berlin Heart Excor in a 64-year-old man. The procedure was successful and echocardiographic examinations documented the exact placement of the left ventricular cannula.
Results and Conclusion: Our new technique ensures a very precise insertion of apical cannulae, because the left ventricular shape and filling are not impaired.
Deng MC, Edwards LB, Hertz MI, Rowe AW, Kormos RL. 2005. Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation: third annual report—2005. J Heart Lung Transplant 24:1182-7.nFrazier OH, Rose EA, Oz MC, et al. 2001. Left ventricular assist system multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg 122:1186-95.nFrazier OH, Gregoric ID, Cohn WE. 2006. Initial experience with non-thoracic, extraperitoneal, off-pump insertion of the Jarvik 2000 Heart in patients with previous median sternotomy. J Heart Lung Transplant 25:499-503.nHirokuni A, Tomohiro M, Tomoya J, et al. 2006. A new multisuction cardiac positioner for multi-vessel off-pump coronary artery bypass grafting. Innovations 1:126-30.nKaczmarek I, Sachweh J, Groetzner J, et al. 2005. Mechanical circulatory support in pediatric patients with the MEDOS assist device. ASAIO J 51:498-500.nKotschet E, Aggarwal A, Esmore D, Kaye D. 2005. Left ventricular apical infection and rupture complicating left ventricular assist device explantation in 2 women with postpartum cardiomyopathy. J Heart Lung Transplant 24:350-4.nMcCarthy PM, Smedira NG. 2000. Implantable LVAD insertion in patients with previous heart surgery. J Heart Lung Transplant 19(8 suppl):S95-100.nSchmid C, Scheld HH, Tjan TD. 2005. Biapical cannulation for biventricular support with the pneumatically driven Excor system. ASAIO J 51:126-7.n