Preperitoneal insertion of the HeartMate 1000 IP implantable left ventricular assist device.

During a 16-month period, 12 consecutive patients underwent insertion of a HeartMate 1000 IP left ventricular assist device in a preperitoneal pocket that separated the device from the abdomen. All patients were in cardiogenic shock awaiting heart transplantation. Preoperatively, the mean cardiac index was 1.6 L.min-1.m-2, with 11 patients on intraaortic balloon pump support and 2 on extracorporeal membrane oxygenation. The pocket was formed below the rectus abdominis and internal oblique muscles and above the posterior rectus sheath. The pump fit easily in all patients. One patient died of progressive multiorgan failure. Four patients are still on support. Seven patients underwent successful transplantation after a mean duration of 55 days of support (mean pump index was 3.1 L.min-1.m-2 during support). One patient had driveline revision because of an exit site infection but had successful transplantation. The pump was explanted without difficulty at each transplant operation. All patients having transplantation are alive and well. Preperitoneal insertion of the HeartMate left ventricular assist device can be safely performed and may avoid problems posed by intraabdominal left ventricular assist device insertion.