Ventricular assist devices are mechanical circulatory assist devicesdivided into pulsatile or continuous flow, which may be centrifugal or pulsatile pumps. The HeartWare® LVAD is an implantable continuous flow centrifugal pump that is designed to provide flows up to 10 L/min in a compact device which is lightweight and portable. It is FDA approved as a bridge to transplant. In the seventh Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) report, only 1% of the 1357 patients with continuous flow left ventricular assist devices (CFLVADs) that were implanted with the bridge-to-transplant (BTT) strategy had sufficient myocardial recovery to allow explant of the LVAD at 12 months.
Very few surgical techniques have been described to separate the patient from the LVAD once recovery has occurred. Majority are managed by explantation of the LVAD on cardiopulmonary bypass (CPB), with ischemic or fibrillatory arrest. To avoid CPB, new and different minimally invasive techniques have become widespread, and it has also brought innovations in anaesthesia management.