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Chronologic Changes in Residual False Lumen Under Continuous-Flow Circulation.

Tomoki Ushijima1, Yoshihisa Tanoue1, Yasuhisa Oishi1

  • 1Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan.

The Annals of Thoracic Surgery
|November 29, 2020
PubMed
Summary

A rare intraoperative aortic dissection during HeartMate II implantation was repaired with total aortic arch replacement. Follow-up CT scans showed the residual false lumen gradually thrombosed over time, with initial enlargement followed by reduction.

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Area of Science:

  • Cardiovascular Surgery
  • Aortic Diseases
  • Medical Devices

Background:

  • Intraoperative type A aortic dissection is a rare but serious complication during left ventricular assist device implantation.
  • Continuous-flow left ventricular assist devices (LVADs) like the HeartMate II are crucial for managing advanced heart failure.
  • Aortic dissection poses significant risks, necessitating prompt and effective surgical intervention.

Observation:

  • A rare case of intraoperative type A aortic dissection occurred during HeartMate II implantation.
  • Emergent total aortic arch replacement was performed to address the dissection.
  • Follow-up computed tomography (CT) revealed gradual thrombosis of the residual false lumen despite antithrombotic therapy.

Findings:

  • The aortic diameter transiently enlarged at 1 year postoperatively.
  • A reduction in aortic diameter was observed at 3 years postoperatively.
  • The residual false lumen demonstrated a natural thrombotic progression over time.

Implications:

  • This case highlights the importance of vigilant monitoring and prompt management of aortic complications during LVAD procedures.
  • Understanding the natural history of residual false lumens after aortic repair in LVAD patients is crucial for long-term outcomes.
  • The findings suggest that the aortic false lumen may resolve spontaneously, even with continuous-flow LVAD support.