Operative Strategies to Reduce Complications in Novacor Left Ventricular Assist Device Placement

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Abstract
The original Novacor left ventricular assist device (LVAD) implant procedure has been extensively modified since its introduction. Our goal is to describe, in a concise and comprehensive fashion, the status of this evolution as we currently employ it at our institution. We will also investigate the possible impact of the adoption of this current methodology on the incidence of perioperative hemorrhage at our institution. The number of units of blood transfused on the day of implant surgery and the incidence of reexploration for postoperative hemorrhage were compared between the early group of consecutive patients implanted before adoption of the described implant strategy (n = 10) and the late group of consecutive patients implanted after uniform implementation of this methodology (n = 20). Operative and immediate postoperative hemorrhage, as demonstrated by the number of blood transfusions on the day of implant surgery, was significantly reduced in the group of consecutive patients implanted after adoption of these techniques when compared to the group of patients implanted prior to technical modification. The currently utilized Novacor LVAD implant procedure is described in detail. The amount of blood transfused on the implant day has significantly decreased since the uniform adoption of the current procedure, suggesting that the degree of perioperative hemorrhage has been favorably affected. Although implantation complications can be surgeon, device, institution and patient-specific, the strategies employed in the current implant procedure may be helpful at other heart failure centers.

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