[Conversion Surgery from Extra-corporeal to Implantable Ventricular Assist Devices].

Extra-corporeal ventricular assist device( VAD), or Nipro VAD in Japan, is still one of the indispensable treatment options for patients with acute cardiogenic shock or post-cardiotomy shock, who are not eligible for heart transplantation. Once they were stabilized and enrolled to heart transplantation, or indicated to destination therapy in the future, a conversion surgery from Nipro VAD to implantable VAD( iVAD) as bridge-to-transplant is essential for them to return to social life. Three tips for successful conversion surgery are summarized in the current manuscript. Firstly, we surgeons should be deliberate considering a conversion surgery when we conduct the first Nipro VAD implantation. For example, we cover mediastinal structure with a 0.1 mm Gore-Tex and avoid an extensive anatomical dissection, which could make the next surgery more complicated. Secondly, conversion surgery should be performed after the patient completely recovers from Nipro VAD surgery. And thirdly, we should pay a specific attention to prevent a future infection of iVAD, which is caused by an existing infection of Nipro VAD exit sites. Conversion surgery from Nipro VAD to iVAD was originated in Japan and its case numbers are limited. Experienced institutions should keep their efforts to disseminate its pitfalls to other institutions.