Pulmonary embolism and LVAD: is there compatibility?

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Dilated cardiomyopathy presents a significant challenge in heart failure management, often necessitating advanced interventions.
• Pulmonary artery thrombosis is a rare but serious complication that can exacerbate heart failure symptoms.

Observation:

• A 41-year-old male with dilated cardiomyopathy and heart failure refractory to medical therapy presented for evaluation of heart transplantation or mechanical cardiac support.
• Preoperative contrast computed tomography (CT) revealed pulmonary thrombosis in the left branch of the pulmonary artery.

Findings:

• The patient underwent simultaneous thrombus-arteriectomy and implantation of a Heartware left ventricular assist device (LVAD).
• Post-procedure, the patient was discharged on anticoagulant and antiplatelet therapy per institutional protocol.
• After 24 months of LVAD support, follow-up CT confirmed the complete resolution of pulmonary artery thrombosis.

Implications:

• Simultaneous surgical intervention for pulmonary artery thrombosis and LVAD implantation is a viable strategy for select heart failure patients.
• This combined approach can effectively manage complex cardiovascular conditions, potentially avoiding the need for heart transplantation.
• LVADs offer a crucial bridge to recovery or transplantation, improving outcomes in severe heart failure with associated complications.