Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy.
Division of Vascular Surgery, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy.
Artif Organs. 2022 Nov;46(11):2319-2324. doi: 10.1111/aor.14354. Epub 2022 Jul 8.
Left ventricular assist device (LVAD) has emerged as an effective surgical therapy for end-stage heart failure. In an attempt to reduce invasiveness and avoid difficult sternal re-entries, alternative surgical approaches have been adopted. In particular, when the thoracic aorta is severely diseased or difficult to expose, subclavian arteries could serve as site for outflow graft anastomosis. However, major concerns regarding the utilization of subclavian arteries are the small caliber of these vessels that could lead to inadequate LVAD flow, arm complications related to excessive blood flow, and possible outflow graft compression. In the present case series, we describe an innovative technique for LVAD implantation, in which the left subclavian artery was employed as an outflow graft anastomosis site, and the left ventricular apex was approached through a mini-thoracotomy. Technical issues were considered to prevent possible complications: the adequacy of left subclavian artery diameter, the banding of the artery distal to the anastomosis site to limit left arm overflow, and the outflow graft covering with a reinforced vascular graft to avoid any external compression. During follow-up, the technique reported was found to be effective in ensuring good LVAD function and flow, and no complications related to the procedure were reported.
左心室辅助装置（LVAD）已成为治疗终末期心力衰竭的有效手术治疗方法。为了降低侵袭性并避免胸骨再次进入的困难，已经采用了替代的手术方法。特别是当胸主动脉严重病变或难以暴露时，锁骨下动脉可作为流出吻合口的部位。然而，使用锁骨下动脉存在一些主要问题，这些血管的口径较小，可能导致 LVAD 流量不足，与过多血流相关的手臂并发症，以及可能的流出吻合口压迫。在本病例系列中，我们描述了一种 LVAD 植入的创新技术，其中将左锁骨下动脉用作流出吻合口部位，通过小开胸术进入左心室心尖。考虑了技术问题以预防可能的并发症：左锁骨下动脉直径的充足性，在吻合部位远端对动脉进行绑扎以限制左臂溢出，以及用增强型血管移植物覆盖流出吻合口以避免任何外部压迫。在随访期间，发现所报道的技术可有效确保良好的 LVAD 功能和流量，并且未报告与该手术相关的任何并发症。
