Abstract
A two-stage explantation of a left ventricular assist device (LVAD) was performed on 47 year old afro-american gentlemen with non-ischemic dilated cardiomyopathy (DCM) who was successfully bridged to recovery. After he suffered a stroke caused by a VAD thrombosis with embolisation, the VAD outflow graft was first ligated using minimally-invasive approach. Two months later, the device was explanted and a manufactured titanium plug was placed into the sewing ring. This stepwise procedure might be beneficial in cases of high thromboembolic risk and in patients who suffered a thromboembolic event previously.
Highlights
Ventricular assist devices (VADs) provide an established mechanical support of patients with end-stage heart failure as bridge to transplantation, bridge to recovery and chronic support [1].successful left ventricular assist device (LVAD) explantation can only be performed in a restricted number of patients who meet the criteria of myocardial recovery [2,3]
Our institution has reported encouraging results with pharmacological therapy combined with continuousflow or pulsatile-flow LVADs as bridge to recovery [2,3]
We present our experience with staged LVAD explantation in a patient with myocardial recovery who suffered an embolic stroke following LVAD thrombosis
Summary
Ventricular assist devices (VADs) provide an established mechanical support of patients with end-stage heart failure as bridge to transplantation, bridge to recovery and chronic support [1]. Full sternotomy LVAD explantation is shown to be feasible; it might be associated with increased risk of intraoperative bleeding, need for blood transfusions and postoperative ventricular dysfunction. We present our experience with staged LVAD explantation in a patient with myocardial recovery who suffered an embolic stroke following LVAD thrombosis. This approach was used with the view to preventing potential flush of clots from the thrombosed LVAD reducing the risk of further potential stroke. A transthoracic echocardiogram (TTE) confirmed no serious heart dilatation after 15 min of exercise Due to these evident signs of myocardial recovery the patient was admitted for an elective LVAD removal. Symptoms, no orthopnea and no peripheral oedema over 6 months follow-up
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