Endarterectomy ; methods ; Humans ; Male ; Middle Aged ; Pulmonary Artery ; injuries ; Pulmonary Embolism ; surgery

BACKGROUND: The surgical technique for biventricular assist device(BVAD) implantation has mainly consisted of cannulation procedures. A median sternotomy has been the technique of choice as it gives a surgeon an excellent exposure of the heart. However, considering that most patients require a future sternotomy or already have a previous sternotomy, sternotomy-related complication remains a major concern in BVAD implantation. Based on this consideration as well as the clinical experiences of conventional heart surgery, the authors have hypothesized that the cardiac chambers for BVAD cannulation can be approached from the right side of the heart. The purpose of this study to develop a novel surgical technique of right thoracotomy for BVAD implantation in an animal study. MATERIAL AND METHOD: For last two years, 16 (11 calves, 3 canines, and 2 sheep) out of 30 experimental animals with AnyHeart implantation underwent a right thoracotomy. The device was used as an implantable BVAD in 14 animals, a wearable BVAD in 1, and an implantable LVAD in 1. The chest cavity was entered through the 4th intercostal space or the 5th periosteal bed. As for the BVAD use, a right inflow cannula was inserted into the right atrial free wall and a right outflow cannula was grafted onto the main pulmonary artery. A left inflow cannula was inserted into the interatrial groove and a left outflow cannula was grafted on the innominate artery of the ascending aorta. The connecting tubeswere brought out through the thoracotomy wound and connected to the pump located in the subcutaneous pocket at the right flank. RESULT: Except for the 5 animals for a fitting test or during the early learning curve, all recovered smoothly from the procedures. The inflow drainage allowed the pump output 6.5 L/min at the maximum with 3-3.5 L/min in an average. Of the survivors, there noted no procedure-related mortality or morbidity. Necropsy findings demonstrated the well-positioned cannula tips in the each cardiac chamber. CONCLUSION: The technique of right thoracotomy approach in AnyHeart implantation is simple, safe, and reproducible. As it can avoid sternotomy-orresternotomy-related complications, the authors suggest a right thoracotomy approach as one of the techniques for BVAD implantation. The technique would also be suggested as an alternatitve for a median sternotomy in a certain group of patients with various VAD implantations.
Animals ; Aorta ; Brachiocephalic Trunk ; Catheterization ; Catheters ; Drainage ; Heart ; Heart, Artificial ; Humans ; Learning Curve ; Mortality ; Pulmonary Artery ; Sternotomy ; Survivors ; Thoracic Surgery ; Thoracotomy* ; Thorax ; Transplants ; Wounds and Injuries

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.
Thigh/pathology ; Pulmonary Artery/*injuries/surgery ; Liposarcoma/drug therapy ; Humans ; Foreign-Body Migration/*complications/surgery ; Female ; *Equipment Failure ; Embolism/*etiology/surgery ; Catheters, Indwelling/*adverse effects ; Catheterization, Central Venous/*adverse effects/instrumentation ; Adult