A HeartMate 3 Implantation without Anticoagulation

Abstract

<h3>Introduction</h3> Left ventricular assist device (LVAD) implantation is an established treatment for advanced heart failure. LVADs are implanted using intra-operative anticoagulation with or without cardiopulmonary bypass. However, the anticoagulation strategy remains uncertain in patients with heparin-induced thrombocytopenia (HIT) and undergoing left ventricular assist device (LVAD) implantation. We report the first anticoagulant free implantation of a HeartMate 3. We prospectively followed a patient with heart failure and HIT. <h3>Case Report</h3> A 65-year-old man with ischemic cardiomyopathy was admitted with cardiac decompensation, pulmonary edema and cardiogenic shock in a regional clinic where VA-ECMO-therapy was initiated. After transfer to our hospital, he had 2 episodes of oxygenator thrombosis and later he was diagnosed with HIT. He was anticoagulated with argatroban for his VA-ECMO. The preoperative course was further complicated due to recurrent bronchial bleeding. A decision was made to proceed with mechanical circulatory support using a HeartMate 3 ventricular assist device (Abbott, Chicago, IL). To avoid the risk of bronchial bleeding, we performed an anticoagulant-free HeartMate 3 implantation through a full sternotomy on perioperative VA-ECMO support. Argatroban infusion was stopped 2 days before surgery and started again 4 days postoperatively and later switched to phenoprocoumon. There were no episodes of bronchial bleeding. More importantly, there was no signs of thrombosis, organ damage or neurological dysfunction and pump parameters remained stable during follow-up. <h3>Summary</h3> Anticoagulant-free HeartMate 3 implantation appears to be a safe alternative to performing implantation using alternative anticoagulation in patients with HIT.