Off-pump HeartWare ventricular assist device implantation with outflow graft anastomosis to the left subclavian artery.

A novel, off-pump implantation technique for the HeartWare ventricular assist device with outflow graft anastomosis to the left subclavican artery is described. Cannulation of the left ventricular apex is performed through an incision in the left fourth or fifth intercostal space. The outflow graft is anastomosed to the left subclavian artery after tunneling through the left thoracic cavity and the first intercostal space. This technique is especially appealing in redo cases as well as in patients with significant calcifications of the ascending aorta or in destination-therapy patients.