After the patient is asleep, a device called the Swan-Ganz catheter is often inserted into the jugular vein in the neck and threaded to the pulmonary artery (which goes from the lungs to the heart). The catheter can be used to give medication and measure the oxygen levels in the blood. A breathing tube (endotracheal tube) will also be inserted into the mouth and down the windpipe (trachea) to maintain an airway and deliver the anesthesia. A urinary catheter is also inserted and connected to a collection bag to measure the patient’s urine output.

The surgeon will then make the necessary incision(s). If the surgeon is implanting a left ventricular assist device (LVAD), he or she will connect a tube from the LVAD to the left ventricle and another tube from the external part of the LVAD through the abdomen and to the aorta. Sometimes a heart-lung machine is used during the procedure to support the patient’s circulation during LVAD installation. If the surgeon is implanting a right ventricular assist device (RVAD), he or she will connect a tube from the RVAD to the right ventricle and another tube from the external part of the RVAD to the pulmonary artery. In some patients, both an LVAD and a RVAD will be implanted.

Once the procedure is completed, the incisions in both the heart and the chest are closed (sutured). The entire procedure can take several hours.