Berlin Heart EXCOR Pediatric VAD, Manual, Page: 136 / 250

Chapter 9 Implantation - surgical procedure
Left atrium
The procedure for anastomosis of the left atrium corresponds to the procedure applied
to the right atrium.
ADVICE
Place anastomosis at the junction of the right upper pulmonary vein
and the left atrium. The atrial wall is the recommended implantation
location. The pulmonary vein should be left intact.
9.7 Arterial cannula(e)
Refer to section 9.2: Use of the cannula tunneling tip, page 117.
ADVICE
For cannulae supplied with a forming wire, the transcutaneous tunnel
should be created and the cannula advanced through the tunnel and
skin ins cis ion prior to the anastomosis.
9.7.1 Creating a transcutaneous tunnel for arterial cannula
WARNING
Care must be taken to ensure that the blood pump and cannulae come
to rest in a stable position.
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 smaller than the cannula diameter (to ensure
good ingrowth) but large enough to prevent skin necrosis.
Plan the cannula exit sites appropriately. Leave an adequate bridge of
skin and subcutaneous tissue between the cannula exit incisions to
pre-vent breakdown and necrosis of the skin and tissue. If possible the
cannula exit insicions should be on different planes (see Fig. 9-2,
page 116).
INSTRUCTION
1. Prepare the transcutaneous tunnel. Ensure that the incision is large enough.
2. Prepare cannula tunnel by blunt dissection. IMPORTANT: Do not tunnel trans­
peritoneally.
3. 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.
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