Alternative technique for implantation of biventricular support with heartware implantable continuous flow pump

In this case report, we describe a modification of the biventricular implantation of the HeartWare HVAD. A 28-year-old man with dilative cardiomyopathy presented with biventricular decompensation. The patient underwent implantation of two HeartWare HVADs for biventricular support. Because of low flow of the right pump (2 L/min), a right ventricular angiogram and repeated transesophageal echocardiography (TEE) were done and showed that the pump was compressing the right ventricle. Operative revision was performed, resulting in removal of the right pump and placement into the right atrium, so that it was located in the right pleural cavity. The HVAD fixation ring on the free wall of the right ventricle was left in place, and the opening was closed with an individually designed titanium plug. The findings of this case are that implantation of the HeartWare HVAD for right ventricular (RV) support may be safely performed in atrial position, with individually designed plugs allowing safe and quick removal of the HeartWare pump. This might be used as a "bail-out" strategy when necessary.