Biocompatibility of an apical ring plug for left ventricular assist device explantation: Results of a feasibility pre-clinical study

S. Mariani, T. Li, J. Hegermann, K. Bounader, J. Hanke, T. Meyer, H. Jannsen-Peters, A. Haverich, J.D. Schmitto*, G. Dogan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Patients receiving left ventricle assist devices (LVADs) as bridge to recovery remain a minority with 1%-5% of LVADs explanted after improvement of myocardial function. Nevertheless, considering the growing population of patients supported with LVADs, an increasing demand of new explantation strategies is expected in the near future. A novel plug for LVAD explantation has been developed and its biocompatibility profile needs to be proved. This study tested the biocompatibility of this novel plug in an in vivo ovine model. Methods Six adult Blackhead Persian female sheep received plug implantation on the cardiac apex via minimally invasive approach and were clinically observed up to 90 days. Echocardiography was performed to detect thrombus formation or further plug-related complications. After the observation period, euthanasia was performed and samples including the plug and the surrounding tissues were obtained to be analyzed with correlative light and electron microscopy. Organ necrosis, ischemia and peripheral embolism were investigated. Results Three animals survived surgery and completed the follow-up time without experiencing clinical complications. Echocardiographic controls excluded the presence of an intracavitary thrombus in the left ventricle (LV). Autopsy confirmed no signs of local infection, LV thrombus or peripheral embolism. Light and electron microscopy revealed an intact epithelium covering a layer of connective tissue on the plug surface facing the heart lumen. Conclusions This novel apical plug for LVAD explantation allows for endothelial and connective tissue growth on its ventricular side within 90 days from surgery. Further studies are required to fully demonstrate the biocompatibility of this apical plug and investigate the optimal anticoagulation regimen to be applied after implantation.
Original languageEnglish
Pages (from-to)827-837
Number of pages11
JournalArtificial Organs
Issue number5
Early online date24 Dec 2021
Publication statusPublished - May 2022


  • apical ring plug
  • correlative light and electron microscopy
  • heart failure
  • left ventricle assist device
  • LVAD explantation
  • myocardial recovery

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