Two males in their fifth decade of life with “Stage D” congestive heart failure status and HeartMate 3™ assist device implantation several years prior as a bridge to recovery experienced an improvement of the myocardial function in the follow-up visits, most probably due to lifestyle modification by eliminating the risk factors and strict adherence to guideline-oriented medical treatment. The entire workup of both patients met the mechanical assist device explanation criteria suggested by Berlin Heart Center [1].

Both patients were willing to have a minimally invasive explanation approach through lateral thoracotomy using the recovery plug.

The patients were then prepped and draped in a usual sterile fashion, and a longitudinal left anterior lateral thoracotomy was performed. After careful dissection, the pump and the outflow cannula were identified. Using electrocautery, the pump was mobilized from the surrounding dense adhesion.

After the insertion of an epi-myocardial pacemaker wire to achieve rapid pacing, the screw of the pump was made loose. The lockdown mechanism was opened, the pump was stopped, and the outflow graft was clamped.

After rapid pacing, the pump was removed, and the recovery Plug was swiftly inserted into the sewing ring and then secured (Fig. 2). Afterward, the rapid pacing was terminated, and the drive line was cut with a wire cutter. The pump-related part of the outflow tract and the driveline were removed from the operative field. Using pledgeted 4–0 prolene, the recovery plug was secured and fixed within the myocardium. Using a 3–0 proline, the distal portion of the outflow graft was sewn; then, the clamp was removed. The driveline could be entirely removed from the tunnel. The exit site was packed with iodoform gauze. No apical bleeding occurred after the procedure.

Both patients tolerated all the mentioned procedures well and were monitored in an intensive care unit. After intravenous catecholamine weaning, they were shifted to the surgical floor for further postoperative care, which was uneventful. There was no hospitalization due to heart failure during the follow-up period of four years.

Chemical formula of polydimethylsiloxane (PDMS) and a diagram demonstrating the surface roughness of the silicon plug after applying a laser profilometry with a high-quality average surface roughness (Ra) of 0.13 µm (μm)

The silicon plug is in the hand of the implanting surgeon, and an intraoperative picture with the silicon plug in situ