Surgical approach to continuous-flow left ventricular assist device explantation: A comparison of outcomes

The Texas Heart Institute reports its experience with 27 patients with prior continuous flow LVADs who had undergone varying degrees of device explantation.  Although the numbers are small, the explantation methods ranged from near-complete device removal to driveline transection and removal.  In general, the device explantation technique has evolved over time to a progressively less invasive option.  This experience provides justification for a tailored approach, but lesser degrees of device removal appear to be well tolerated.  The exception may be patients with chronic device infection:  6 of 10 patients with superficial driveline infection required further procedures for either debridement or removal of infected device material.  More radical explantation of device material is recommended in these patients.