Safe, effective off-pump sternal sparing approach for HeartMate II exchange

As left ventricular assist devices (LVADs) have become more widely used for treating patients with advanced heart failure, the incidence of pump dysfunction requiring pump replacement has increased. When dysfunction is due to pump failure or driveline injury, isolated pump replacement can be curative. We have developed a quick, safe pump-exchange technique that avoids a redo sternotomy and cardiopulmonary bypass. We have used this technique to exchange malfunctioning HeartMate II LVADs in 14 consecutive patients. The patients were extubated within 3 to 6 hours, and blood loss and transfusion requirements were nominal. There were no periprocedural deaths or strokes.