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Preservation of right ventricle vascularization that is dependent on left coronary network collateral development is essential during left ventricular assist device implantation to avoid postoperative right heart failure. Our technique was performed on a patient who underwent implantation as a bridge to transplantation; the technique is characterized by providing a moderate lateral and inferior displacement of the inflow cannula position, which achieves both the objectives of respecting the apical course of a left anterior descending coronary artery supplying an occluded right coronary and of maintaining a sufficient orientation degree toward the plane of the mitral valve for correct left ventricular unloading. [ABSTRACT FROM AUTHOR]

In particular, Impella 5.0 can sometimes result in AoV damage4 whose entity may be underestimated prior to LVAD implantation, contributing to the big extent of significant aortic regurgitation diagnosis made in the operating room requiring an unplanned procedure with subsequent increased risk of adverse outcome. We read with interest the paper by Veenis I et al i .1 concerning the effect on outcome of an aortic valve (AoV) procedure during left ventricular assist device (LVAD) implantation in patients enrolled in the ISHLT Mechanically Assisted Circulatory Support (IMACS) Registry. Letter regarding the article 'Survival following a concomitant aortic valve procedure during left ventricular assist device surgery: an ISHLT Mechanically Assisted Circulatory Support (IMACS) Registry analysis'. [Extracted from the article]