Hybrid Exclusion of HeartMate ІІ Left Ventricular Assist Device After Bridge to Recovery

Percutaneous approach to left ventricular assist device decommissioning

OBJECTIVE

To assess the outcomes of a single-center experience with percutaneous left ventricular assist device (LVAD) decommissioning.

BACKGROUND

Patients with LVADs may eventually require their removal, either due to recovery of left ventricular function or recurrent complications. Traditionally, withdrawal of LVAD support has been managed with surgical device explantation, which carries significant procedural risks. Transcatheter LVAD decommissioning, with outflow graft occlusion and driveline transection, has recently been described as an alternative to surgical removal.

METHODS

Here, we report on a retrospective cohort of five consecutive cases treated with transcatheter LVAD decommissioning.

RESULTS

The procedure was effective in all cases, and no patient experienced procedure-related complications. At midterm follow-up, the three patients who had myocardial function recovery were alive and had not experienced heart failure-related symptoms or complications.

CONCLUSION

Percutaneous LVAD decommissioning appears to be a safe and effective approach to LVAD treatment discontinuation.

Left ventricular assist device deactivation following cardiac recovery and pump thrombosis

Left ventricular assist devices (LVADs) have become an increasingly important component of the management of severe heart failure not only as bridge therapy to eventual orthotopic heart transplantation, but also as destination therapy. Timely diagnosis and management of device complications are of vital importance. Rarely, LVAD placement can result in cardiac recovery that may necessitate device removal. While there are reports of minimally invasive LVAD deactivation, there are currently no guidelines for device extraction or deactivation in the setting of cardiac recovery. This is a case of both cardiac recovery and pump thrombosis following LVAD implantation, managed with device inactivation and driveline excision.

HeartMate II pump exchange with HeartMate III implantation to the descending aorta

Removal of the HeartMate II left ventricular assist device (LVAD) usually requires a sternotomy. We report a case of HeartMate III LVAD implantation to the descending aorta via a left thoracotomy while leaving most of the HeartMate II device in place to avoid redo-sternotomy.