CASE REPORT Artificial Heart (Clinical) Successful management of apical abscess after Nipro left ventricular assisted device explantation by removal of apical cuff and omentopexy Shuichi Yoshitake 1 • Yoshifumi Itoda 1 • Kan Nawata 1 • Tomoyuki Iwase 1 • Yasuhiro Hoshino 1 • Mitsutoshi Kimura 1 • Osamu Kinoshita 1 • Haruo Yamauchi 1 • Minoru Ono 1,2 Received: 7 April 2016 / Accepted: 1 August 2016 / Published online: 9 August 2016 Ó The Japanese Society for Artificial Organs 2016 Abstract Nipro-Toyobo-paracorporeal pulsatile flow VAD (Nipro VAD; Nipro, Osaka, Japan) has been used most commonly as a paracorporeal VAD (p-VAD) in Japan. There are few reports describing clinical course of post LVAD explantation and its complication. We herein present two cases of apical abscess after the explantation of the device. SSI is a main risk factor of formation of the apical abscess at the time of LVAD explantation. It is mandatory to perform sufficient debridement and closure of the layers including abdominal muscle and anterior abdominal fascia at exit sites in the explantation surgery. Omentopexy is also helpful for prevention from infection. Routine removal of apical cuff and outflow graft could be considered as one of the options when LVAD is explanted as bridge to recovery. Keywords Nipro VAD Á Surgical site infection Á Apical abscess Á LVAD explantation Background Left ventricular assisted device (LVAD) is effective as bridge to heart transplantation therapy for end-stage heart failure, but its use is associated with a high complication rate, most notably infection. Infection can involve any portion of an LVAD, including the surgical site, driveline, pocket, and pump. Treatment varies depending on location and severity of the infection. Nipro-Toyobo-paracorporeal pulsatile flow VAD (Nipro VAD; Nipro, Osaka, Japan) has been used most commonly in a crash-and-burn case in Japan. LVAD support in a patient with severe left ven- tricular dysfunction sometimes results in sufficient cardiac recovery to wean off the device. At the time of LVAD explantation, the apical cuff is usually left behind. The presence of chronic LVAD associated infection is a sig- nificant risk factor for reoperation after device removal [1, 2]. Complete device explantation (e.g., with heart transplantation) could be considered as the definitive intervention to eradicate the infection [1, 2]. There are few reports describing clinical course of post LVAD explan- tation and its complication. We herein present two cases of apical abscess after the explantation of the device. Case 1 A 44-year-old male patient [Height 183 cm, Weight 77.6 kg, Body surface area (BSA) 1.99 m 2 ] suffered from congestive heart failure due to dilated cardiomyopathy (DCM). No therapeutic strategy such as inotropic support provided him any sufficient improvement. Nipro LVAD was implanted in INTERMACS profile 2 (refractory car- diac failure on inotropes with shock liver). Postoperative course was complicated with readjusting the inflow can- nula angle due to severe hemolysis via redo sternotomy and & Shuichi Yoshitake a1mb1100-thk@umin.ac.jp & Minoru Ono ono-tho@h.u-tokyo.ac.jp 1 Department of Cardiac Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan 2 Department of Cooperative Unit of Medicine and Engineering Research, The University of Tokyo, Tokyo, Japan 123 J Artif Organs (2016) 19:396–398 DOI 10.1007/s10047-016-0924-7