University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.
University of Zagreb School of Medicine, Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia.
ESC Heart Fail. 2023 Jun;10(3):2094-2098. doi: 10.1002/ehf2.14342. Epub 2023 Mar 10.
A 47-year old male with ischaemic cardiomyopathy was referred to us for durable left ventricular assist device placement. He was found to have prohibitively elevated pulmonary vascular resistance for heart transplantation. He underwent HeartMate 3 left ventricular assist device implantation, with additional temporary right ventricular assist device (RVAD) placement. Following a 2-week period of unweanable temporary right ventricular support, the patient was switched to durable biventricular support with two Heartmate 3 pumps. The patient was placed on a transplant waiting list but was not offered a heart for over 4 years. While on Heartmate 3 biventricular support (BiVAD), he returned to full activity and enjoyed an excellent quality of life. He underwent laparoscopic cholecystectomy 7 months after the BIVAD implant. After 52 months of uneventful BiVAD support, he presented with a combination of adverse events that occurred over a short period. These included subarachnoidal haemorrhage and a new motor deficit, followed by RVAD infection and RVAD low-flow alarms. After over 4 years of unimpeded RVAD flows, new imaging revealed an outflow graft twist with subsequent flow reduction. The patient underwent heart transplantation after a total of 1655 days of Heartmate 3 BiVAD support and continues to do well on latest follow-up.
一位 47 岁的男性患有缺血性心肌病，被转介给我们进行耐用型左心室辅助装置的植入。他被发现肺动脉血管阻力过高，不适合进行心脏移植。他接受了 HeartMate 3 左心室辅助装置植入，并同时临时植入了右心室辅助装置（RVAD）。在两周的临时右心室辅助装置不可脱机期间，患者切换至两个 Heartmate 3 泵的耐用型双心室支持。患者被列入移植等待名单，但在 4 年多的时间里没有获得心脏。在使用 Heartmate 3 双心室辅助装置（BiVAD）期间，他恢复了全面的活动能力，并享有极佳的生活质量。他在 BiVAD 植入后 7 个月接受了腹腔镜胆囊切除术。在经历了 52 个月无并发症的 BiVAD 支持后，他在短时间内出现了一系列不良事件。这些事件包括蛛网膜下腔出血和新的运动功能障碍，随后是 RVAD 感染和 RVAD 低流量警报。在经过 4 年多无阻的 RVAD 流量后，新的影像学检查显示流出移植物扭曲，随后流量减少。患者在接受了 1655 天的 Heartmate 3 BiVAD 支持后接受了心脏移植，并在最新的随访中继续保持良好状态。
