Intraoperative Management of Left Ventricular Assist Device Explantation: Complications and Lessons Learned

Abstract

Abstract Left Ventricular Assist Devices (LVADs) are increasingly being used in patients with advanced heart failure as a bridge to transplant, destination therapy, and even as a bridge to recovery1-3. Current LVADs, in particular the HeartMate 2 and the newer generation HeartMate 3 and HeartWare, have evolved to be valveless which have markedly improved their durability, miniaturization, and reliability4. However, an underappreciated consequence of the valveless design is that they can lead to marked left ventricular (LV) dilatation and irreversible cardiac injury when they are turned off in emergencies such as injury to the outflow graft during sternotomy. This unintended consequence was the case in our patient who presented to the operating room for LVAD explantation after full recovery from her post-partum cardiomyopathy that ultimately culminated in her receiving a heart transplant. It is important that cardiac anesthesiologists, surgeons, and perfusionists understand the potential catastrophic consequences of turning off LVADs in emergent situations and mitigation strategies to avoid potentially irreversible cardiac and pulmonary injury.