Technique of right heart protection and deairing during Heartmate vented electric LVAD implantation

Continued experience with the TCI Heartmate Ventricular Assist System has led to improvements in our ability to avoid and manage right heart dysfunction during weaning from cardiopulmonary bypass. The advent of the electric device has intensified the need for these techniques because of its elevated minimal heart rate (50 beats/min) at start-up and the demands this places on the native right heart. We have developed and here describe a technique we have used successfully in our last 8 patients to assist in deairing and filling of the ventricular assist device, to partially support the right heart during the initial wean from cardiopulmonary bypass, and to avoid occasional overdistention of the right heart during early high left ventricular assist device flow.