removed, disconnected from the old (thrombosed or otherwise damaged) pump, and connected to the new pump. Thereafter, the polytetrafluoroethylene (Gore-Tex) graft should be closed (using suture or clips) to protect against adhesion and to facilitate any unlikely future exchange of the pump. We use the technique described for all HeartWare HVAD implantation approaches, that is, median sternotomy and left lateral or bilateral thoracotomy. To avoid twisting of the outflow graft during aortal anastomosis, the position of the black line on the outflow graft should be kept in mind. This technique has been routinely used in our center since the last 100 HVAD implantations. No evidence of increased infection has been noted. In 2 cases in which the kinking protector was covered, pump exchange was performed fast and without any complications. During heart transplantation in the described patients, reopening of the chest and separation of the heart from pericardium also were less traumatic.
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