Abstract
Introduction Left ventricular assist devices (LVAD) provide durable mechanical circulatory support (MCS) as bridge to heart transplantation (BTT). Despite significant advances, LVAD therapy is limited by long-term complications including right ventricular (RV) failure and aortic insufficiency (AI). We report an LVAD patient who presented with cardiogenic shock and successfully bridged to heart transplantation (HT) with biventricular (BiV) Impella support. Case Presentation A 33-year-old man with non-ischemic cardiomyopathy status post HeartWare LVAD as BTT 5 years prior was admitted with progressive nausea and fatigue. Physical exam was notable for mean arterial pressure of 64 mmHg, jugular venous distension with prominent V-waves, RV heave, and cool extremities. LVAD interrogation showed decreased flows (2.7-2.9 L/min) and diminished pulsatility ( Discussion BiV Impella is a minimally invasive option for BiV MCS and may be preferable in patients who have bleeding diathesis or manifest RV failure after LV MCS. This is the first report of a successful bridge to HT with BiV Impella support in an LVAD patient.
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