Successful combined procedure of HeartMate II left ventricular assist device implantation and minimally invasive transapical aortic valve replacement

Abstract

Left ventricular assist device (LVAD) implantation is an accepted treatment for patients with end-stage heart failure, either as a bridge to transplantation or destination therapy. The newer continuous-flow LVAD HeartMate II LVAD (Thoratec Corp, Pleasanton, Calif) represents the current generation of devices and received CE mark and Food and Drug Administration approval, resulting in approximately 3500 implantations in patients worldwide. Severe aortic valve regurgitation remains a strict contradiction to the use of LVADs. We present a combined treatment with implantation of a HeartMate II LVAD after successful transapical aortic valve replacement in a 51year-old patient with end-stage heart failure and severe aortic regurgitation. Transapical transcatheter aortic valve implantation (TA-AVI) was introduced to clinical use byWalther and colleagues in 2007, after the first implantation in humans by Cribier and colleagues in 2002. TA-AVI reflects an alternative operative strategy to treat aortic valve disease in patients with advanced age and severe comorbidities, who present a high risk for open surgery with cardiopulmonary bypass (CPB).