Preoperative and intraoperative extracorporeal membrane oxygenation adoption for long-term left ventricular assist device implantation

Selected patients who fail to be weaned from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may be considered for durable left ventricular assist devices (LVADs). These high-risk patients are usually converted to a cardiopulmonary bypass (CPB) machine at the time of VAD implantation surgery. The CPB may cause activation of the systemic inflammatory response with associated deleterious effects on the coagulation system that can lead to bleeding, thrombosis and increased blood product transfusion (1). In a recent study from our group, we were able to demonstrate the advantages of omitting CPB at the time of VAD implantation surgery (2,3). Based on the outcome of our study, LVAD implantation for patients on VA-ECMO is performed at our institution without conversion to CPB. We describe here the technique of HeartMate 3 (Abbott, Chicago, IL, USA) implantation in a patient on VA-ECMO