Successful repair of a ventricular assist system percutaneous lead

A patient with an implanted, electrically powered, ventricular assist devic e (Thermo Cardiosystems VE HeartMate) experienced a partial break of the pe rcutaneous lead 5 months after implantation. The break (limited to the Sili cone rubber tube) occurred at the junction of the lead with the Y-connector to the controller and vent, leaving approximately 5 cm of exposed lead fro m the skin exit site to the connector. Electronic and pumping functions of the pump continued, but the opening in the lead (which went more that half way around the circumference) prevented the use of pneumatic actuation as a back-up mode for pump operation, and placed the pump at risk for contamina tion. Repair of the lead without surgical intervention was desirable, with ease of repair and minimal risk to the patient being the top priorities. Th e use of multiple layers of heat-shrink tubing or external metal stents was ruled out in favor of a three stage repair procedure. The first stage invo lved the removal of the Dacron velour in-growth material from the lead to e xpose the underlying Silicone rubber tube. While the opening in the tube wa s held shut, a coating of medical grade Silicone rubber adhesive was applie d to the tube, then wrapped with a woven Dacron mesh, followed by two layer s of plastic wrapping material to protect the adhesive. This initial layer was secured by an external stent of tubing with cable ties. After several d ays to allow for complete curing of the adhesive, the adhesive coating with mesh was repeated. The final step involved a double layer wrap of a 1 mm t hick Silicone rubber sheeting with mesh incorporation and adhesive secured in place with cable ties. After completion of the repair and verification o f the ability to operate the device with pneumatic actuation, the patient w as discharged with no recurrence of the problem after 8 months of weekly fo llow-up. This experience demonstrates the need to clinically anticipate com ponent repair or replacement without total device replacement in future imp lantable blood pump systems.