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Left Ventricular Aneurysm Resection and LVAD Implantation Through Median Sternotomy
This video illustrates the authors' surgical strategy for LVAD (Jarvik 2000 FlowMaker®) implantation and left ventricular aneurysm resection in a 55-year-old male with end stage congestive heart failure and a huge left ventricular aneurysm.
The operation was performed through median sternotomy. The pedestal was implanted in the retro-auricular area. This approach has the advantage of a low incidence of infection and good fixation of the pedestal on the bone. The power cable was tunnelled through the neck below the sternocleidomastoid muscle and below the anonymous vein in the chest.
On induced ventricular fibrillation, aneurysm resection was performed together with endocardial resection of scar tissue and linear reconstruction of the left ventricle. Jarvik 2000 LVAD was implanted in postero-apical position about 3 cm below the LV reconstruction. The outflow graft of the LVAD was anastomosed to the ascending aorta. The patient was extubated the next morning. He was discharged to home on the 10th postoperative day with an INR between 2-2.5. At six-month follow up the patient was in NYHA class I, with no ventricular arrhythmias and no anticoagulation related complications.
Clarification: In the video "10 years ago" over the angiogram means that the patient underwent coronary angiography for acute myocardial infarction 10 years ago. After 10 years, coronary angiography was repeated as a preoperative study. The exam showed the same results as the previous angiogram.