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Published on: July 18, 2014
Left ventricular assist device implantation combined with surgical ventricular reconstruction
Alexander M Chernyavskiy1, Andrey V Marchenko, Vladimir V Lomivorotov
1Aorta and Coronary Arteries Surgery Department, Research Institute of Circulation Pathology, Novosibirsk 630055, Russia.
Insights
A 45-year-old man with severe heart failure underwent ventricular reconstruction and received a Berlin Heart INCOR left ventricular assist device. This approach served as a bridge to heart transplantation, improving his condition.
Area of Science:
- Cardiology
- Cardiac Surgery
- Mechanical Circulatory Support
Background:
- A 45-year-old male presented with advanced ischemic heart disease, severe mitral valve insufficiency, and New York Heart Association functional class IV congestive heart failure 9 months post-myocardial infarction.
- He had a left ventricular aneurysm with significant thrombosis, 3-vessel coronary artery disease, and impaired left ventricular function with low myocardial reserve.
Observation:
- The patient exhibited severe left ventricular impairment and pronounced apical thrombosis.
- Echocardiography revealed low myocardial reserve, indicating a high surgical risk for combined ventricular and mitral valve reconstruction with revascularization.
Findings:
- A strategy of ventricular reconstruction combined with a Berlin Heart INCOR left ventricular assist device implantation was chosen as a bridge to heart transplantation.
- The patient experienced an uncomplicated recovery and symptomatic improvement, enabling discharge after 20 days.
Implications:
- This case highlights a viable therapeutic option for high-risk patients with advanced heart failure and left ventricular aneurysms.
- Ventricular assist devices can effectively stabilize patients, facilitating bridge-to-transplant strategies in complex cardiac conditions.
Abstract:
Nine months after sustaining a transmural anteroseptal myocardial infarction, a 45-year-old man presented with ischemic heart disease, severe mitral valve insufficiency, New York Heart Association functional class IV congestive heart failure, and a left ventricular aneurysm. Coronary angiography revealed 3-vessel disease. Echocardiography showed severe left ventricular impairment, pronounced thrombosis in the left ventricular apex, and low myocardial reserve. To reduce the high risk of performing left ventricular and mitral valve reconstruction concurrently with revascularization, we decided to perform ventricular reconstruction and to implant a Berlin Heart INCOR left ventricular assist device as a bridge to heart transplantation. The patient had an uncomplicated recovery, was discharged from the hospital with symptomatic improvement after 20 days, and was placed on the list for heart transplantation. We describe the patient's case, the surgical procedure, and the reasoning behind the chosen course of treatment.
