Subcostal Approach to Replacement of a HeartMate II Device: Indications and Technique

LVAD therapy has provided an adjunct to pharmacotherapy in the management of heart failure. Despite great success, these particular devices carry their own risks including pump thrombosis, hemolysis, infection or device malfunction. At times, it is necessary to exchange these devices and to approach this surgically requires careful preoperative assessment and a diligent surgical approach. We describe our approach to exchanging the HeartMate II LVAD device through a left subcostal incision.