Left ventricular assist device implantation combined with hemiarch replacement for severe aortic atherosclerosis

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Heart Failure Management

Background:

• Left ventricular assist device (LVAD) implantation is a key therapy for severe heart failure.
• Stroke is a recognized complication following LVAD procedures.
• The safety and efficacy of combining LVAD implantation with aortic surgery for severe aortic atherosclerosis remain largely unexplored.

Purpose of the Study:

• To describe a novel surgical technique combining LVAD implantation with hemiarch replacement in a patient with severe aortic atherosclerosis.
• To assess the feasibility and safety of this combined approach in reducing perioperative stroke risk.

Main Methods:

• A 72-year-old male patient with advanced heart failure underwent HeartMate 3 LVAD implantation.
• Severe ascending aorta atherosclerosis necessitated hemiarch replacement using cardiopulmonary bypass, moderate hypothermia, and bilateral antegrade cerebral perfusion.
• Outflow graft anastomosis was performed to an artificial ascending aortic graft post-replacement.

Main Results:

• The combined LVAD implantation and hemiarch replacement procedure was successfully completed.
• The patient experienced no postoperative complications, including neurological deficits.
• This technique effectively managed both severe heart failure and severe aortic atherosclerosis.

Conclusions:

• LVAD implantation combined with aortic replacement is a potentially viable strategy for carefully selected patients.
• This approach can mitigate the risk of perioperative stroke in patients with severe aortic atherosclerosis undergoing LVAD implantation.
• Further research is warranted to validate this combined surgical approach in a broader patient population.