T. AKUTSU, H. TAKAGI AND H. TAKANO 
279 
DACRON GRAFT 
DACRON FELT 
SILICONE TUBE 
WITH 
STAINLESS STEEL RING 
(FROM ABOVE) 
Figure 3. — Techniques of connection of the inlet cuff to the left atrium in the B-LHAD implantation. Series of 
of anastomosis starts from upper left proceeding to upper right and lower right. 
and the conduit by a ligature on the distal side 
and by a continuous suture on the proximal 
side. 
Upon completion of two anastomoses, the 
conduits were connected to the peristaltic by- 
pass-type heart assist device using a stainless 
steel ring coated completely with Silastic. After 
the chest was closed in routine fashion, the de- 
vice was carefully filled with heparinized nor- 
mal saline, and fixed on the left chest wall (Fig- 
ure 4) . 
IMPLANTATION OF S-LHAD 
The chest was opened through the fifth inter- 
costal space both in dogs and calves. The outlet 
side which was provided with a Dacron graft 
was first connected to the descending aorta by 
an end-to-side anastomosis. Connection of the 
inlet side differed in dogs and calves. 
Dogs 
In dogs the inlet side of Dacron graft was 
connected to the ascending aorta originally by 
an end-to-side anastomosis. Then the ascend- 
ing aorta was ligated or dissected and closed be- 
tween the anastomosis and the brachiocephalic 
artery. Later, an end-to-end anastomosis to the 
ascending aorta was found to be hemodynami 
cally preferable, and a new technique for quiclk 
connection without using a pump-oxygenator 
was developed (Figure 5). The Dacron cuff on 
the inflow side was everted over a metal adap- 
tor ring which was split into 2 parts. After the 
venae cavae were temporarily occluded, a clamp 
was applied to the ascending aorta close to the 
brachiocephalic artery. After cutting the as- 
cending aorta between the clamp and the aortic 
valve, the prepared cuff of the device was in- 
serted into the proximal end of the ascending 
aorta and held in place with a ligature applied 
to the aorta against the adaptor ring. The 
