T. AKUTSU, H. TAKAGI AND H. TAKANO 
281 
Figure 5. — Showing quick connection techniques of 
the inlet cuff of S-LHAD, which eliminates extracor- 
poreal circulation. B: Prepared inlet side cuff with 
the Dacron cuff end everted over a split metal ring. 
C: Prepared inlet side slipped into the proximal bi- 
sected end of the ascending aorta, and a continuous 
suture placed around between the aortic wall and the 
Dacron cuff. D: Continuous suture completed, and a 
wire for temporary fixation of the everted cuff, a silk 
tie for temporary fixation of the aortic wall over the 
ring, and the split metal ring removed. Anastomosis 
completed. 
After the outlet side anastomosis had been 
completed and the outlet conduit was clamped 
between a side tube and the outlet valve, extra- 
corporeal circulation was started using a Trav- 
enol bubble oxygenator and three rotary pumps. 
Following bisection of the ascending aorta, 
French 14 and 8 cannulas were inserted each 
into the left and right coronary arteries. Flow 
for the coronary perfusion was maintained 
around 500 ml/min. Upon completion of end- 
to-end anastomosis between the inlet cuff and 
the proximal end of the bisected ascending 
aorta, residual air was replaced with heparin- 
ized normal saline through a side tube attached 
to the inlet side conduit, and the clamp placed 
between the outlet valve and the outlet side 
side-tube was removed, thus restoring back- 
ward flow into the device from the pump-oxy- 
generator for coronary perfusion. When the 
device with a leaking leaflet outlet valve was em- 
ployed, coronary perfusion was continued after 
implantation was completed. Because immedi- 
ately after the connection was completed the 
heartbeat was usually not strong enough to pro- 
vide sufficient coronary flow, and also the blood 
flowing back into the device and ascending 
aorta from the pump-oxygenator through a 
small common window at the bottom of the 
leaking valve was not sufficient to maintain the 
coronary flow. This precaution, however, was 
not necessary when the device with an air- 
driven valve was used. When the heartbeat 
became strong, the decompression cannula was 
removed and the assist device was activated fol- 
lowing cessation of the extracorporeal circula- 
tion. The distal end of the bisected ascending 
INTERNAL THORACIC A. 
OXYGENATOR 
PUMP 
VENOUS PR. LINE 
Figure 6. — Circuit of extracorporeal circulation during 
implantation of S-LHAD. 
