Background
Over the past several years, there has been a dramatic shift from the use of large pulsatile left ventricular assist devices (LVADs) to the use of smaller continuous-flow devices for the provision of mechanical circulatory support in patients with heart failure.
However, the fundamental issues related to surgical implantation remain the same. That is, most devices use the apex of the left ventricle (LV) as the inflow site to the pump, which subsequently gives off an outflow graft to the aorta, thus bypassing the ailing LV.
This article describes some of the issues related to implantation of LVADs. Although many types of devices are currently available, they do not differ significantly with regard to general implantation technique. Accordingly, this article focuses on the device currently dominant in the United States, the Thoratec HeartMate II. Other devices approved by the US Food and Drug Administration (FDA) include the Jarvik 2000 (Jarvik Heart, New York, NY) and the HeartWare Ventricular Assist System
(HeartWare, Framingham, MA).