Explantation of a CircuLite left ventricular assist device without removal of the inflow cannula: how to do it?

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.

Minimally Invasive LVAD Deactivation in a 65-Year-Old Man with Recurrent Pump Thrombosis and Left Ventricular Recovery

Pump thrombosis is a dire sequela after left ventricular assist device (LVAD) implantation. Treatment comprises antiplatelet agents, anticoagulants, thrombolytic agents, and pump exchange. Although pump exchange is the definitive therapy, it is also the most invasive, often exposing patients to the risks of repeat sternotomy and cardiopulmonary bypass. In some cases, patients experience left ventricular recovery after LVAD implantation. The optimal strategy surrounding the management of LVADs in patients who have experienced ventricular recovery is unknown; techniques range from total system explantation to partial pump resection. Here, we describe a novel means of LVAD deactivation in a 65-year-old man with recurrent pump thrombosis, via percutaneous outflow graft closure in the cardiac catheterization laboratory. We also review the existing literature on surgical and percutaneous LVAD deactivation techniques.

Does CircuLite Synergy assist device as partial ventricular support have a place in modern management of advanced heart failure?

The discrepancy between the number of patients on the waiting list and available donor hearts has led to the successful development of left ventricular assist devices (LVAD) as a bridge to transplantation. The conventional LVADs are designed to provide full hemodynamic support for the end-stage failing heart. However, full-support LVAD implantation requires major surgery, sternotomy and cardiopulmonary bypass in majority of cases. The Synergy Micro-pump is the smallest implantable LVAD and provides partial flow support up to 3 l/min. It was shown that early intervention with this device can provide substantial benefits to patients with severe heart failure not yet sick enough for a full-support LVAD. Due the small dimensions it can be implanted without cardiopulmonary bypass or a sternotomy. The purpose of this article is to review the clinical use of the Synergy Micro-pump as partial hemodynamic support.