13 UDK 616.12-008.315 Review Received: 3. November 2010 Accepted: 26. January 2011. Long-term mechanicaL circuLatory support: surgicaL techniques Davor Barić, Željko Sutlić, Igor Rudež, Daniel Unić, Mislav Planinc, Dubravka Jonjić, Zorana Čekol Department of Cardiac Surgery, University Hospital Dubrava, Zagreb, Croatia Summary Long-term mechanical circulatory support has become a valid treatment option for end stage heart failure. In selected patients’ cases, this therapeutic option has been pro- ven to improve survival, both as a bridge to transplant and as a destination therapy. In this article, we address implantation technique, strategies to prevent excessive bleeding, right heart failure, and driveline and pocket infection. Key words: heart failure; mechanical circulatory support; surgical technique Devices Lef ventricular assist devices (LVADs) are classifed as either pulsatile or non- pulsatile (continuous), based on the nature of the fow they produce. The pulsatile pumps have a mechanical pusher plate or sac that propels blood mechanically or pneumatically, whereas continuous fow pumps are rotary devices that establish continuous fow. Furthermore, continuous fow pumps are either centrifugal or axi- al fow, where centrifugal pumps utilize a rotating disk that spins blood in a circular motion to create centrifugal force to pump blood; an axial fow pump consists of a spinning rotor that propels blood alongside the native circulation. Pulsatile devices, such as Thoratec VAD system, allow lef, right, or bi-ventricular assistance to patients with end stage heart failure. The VAD are prosthetic ventric- les, which are composed of blood sacs inside a hard plastic casing. A pressure/vacu- um system allows the air to enter the casing around the blood sac. This expansion and contraction of the air sacs allows the VAD to fll and eject blood, and provides the body with blood fow similar to that of the native heart. It has been FDA-appro- ved both as a bridge-to-transplant therapy and for post-cardiotomy recovery from Corresponding author: Željko Sutlić E-mail: zsutlic@kbd.hr brought to you by CORE View metadata, citation and similar papers at core.ac.uk