Berlin Heart EXCOR Pediatric VAD, Manual, Page: 134 / 250

Chapter 9 Implantation - surgical procedure
3. Tunnel the LV apex cannula through the transcutaneous passage by using a
pair of forceps to firmly grip the flat end piece of the tunneling tip and pull it
through the cannula tunnel and the skin incision.
IMPORTANT: Do not rotate the cannula while pulling it through the tunnel. At
the end of this procedure, the apex of the heart should be in its native position
without torsion.
4. Terminate ventricular fibrillation if necessary.
9.6 Atrial cannula(e)
Refer to section 9.2: Use of the cannula tunneling tip, page 117.
ADVICE
For atrial cannulae supplied with a forming wire, the transcutaneous
tunnel should be created and the cannula advanced through the tunnel
and skin incision prior to the anastomosis.
For all other atrial cannulae, the sequence is arbitrary.
9.6.1 Creating a transcutaneous tunnel for atrial cannula(e)
WARNING
If possible, always use the cannula tunneling tip provided (see
section 9.2: Use of the cannula tunneling tip, page 117) to advance the
cannula through the prepared transcutaneous tunnel.
If it is necessary to apply a clamp directly to the cannula in order to pull
the cannula through the skin, the following procedures should be
observed:
- Position the clamp at the distal end of the cannula
- After the cannula has been pulled through the skin, cut off and
discard the part of the cannula where the clamp was applied.
- If it is necessary to clamp any other part of the cannula that is not
covered with velour, cover the part of the cannula that will be clamped
with a gauze sponge.
Care must be taken to ensure that the cannulae come to rest in a stable
position free of tension.
Do not touch or manipulate the silicone cannulae with pointed or sharp-
edged objects (e. g. surgical instruments).
Using a pair of forceps, firmly grip the flat end piece of the tunneling tip
and pull it through the cannula tunnel and the skin incision.
IMPORTANT: Do not rotate the cannula while pulling it through the
tunnel.
The incision must be slightly smaller than the cannula diameter (to
ensure good ingrowth) but large enough to prevent necrosis.
1000721x09 Revision 8
124