Wang Xiaodong, Lu Yujie, Liu Zhigang, Rubino Antonino S, Perek Bartlomiej, Wendt Daniel, Pisano Calogera, Goudot Guillaume, Deutsch Oliver, Liu Xiaocheng
Cardiovascular Department, TEDA International Cardiovascular Hospital, Tianjin, China.
Cardiac Surgery, TEDA International Cardiovascular Hospital, Tianjin, China.
J Thorac Dis. 2023 Dec 30;15(12):7130-7139. doi: 10.21037/jtd-23-1642. Epub 2023 Dec 26.
Left ventricular assist device (LVAD) is considered either a destination therapy for patients with end-stage heart failure or heart transplantation bridging. LVAD implantation often causes aortic insufficiency (AI), which requires aortic valve repair. However, severe acute AI does not respond well to medication, and re-operation means higher risk to the patients; the most effective therapeutic strategies for LVAD-induced AI still need further exploration. In this report, we present the first described case of new-onset, severe LVAD-induced AI in China with a patient who underwent transcatheter aortic valve replacement (TAVR) and achieved significant improvement in functional capacity and symptoms with lower operation risk.
A 55-year-old male patient was diagnosed with dilated cardiomyopathy for 14 years. The effect of the medication gradually deteriorated, LVAD (HeartCon) was implanted one year earlier. The patient complained of intermittent chest tightness for one week, which had been aggravated for two days before hospitalization. Echocardiographic findings revealed new-onset, severe LVAD-induced AI. TAVR was performed with a self-expandable stent-valve (TAV30, Vitaflow Liberty). Within minutes, the patient recovered with rapid disappearance of chest tightness and stable vital signs. Before discharge, the position of the artificial valve was fixed without incomplete closure nor thrombus attachment, yielding a left ventricular ejection fraction (LVEF) of 35%. The patient was hospitalized for 38 days, and followed up with outpatient treatment, the condition was stable until 19 June 2023.
TAVR could be an effective, safe, and less invasive means of restoring ejection fraction for patients with a LVAD who develop severe AI.
左心室辅助装置（LVAD）被认为是终末期心力衰竭患者的目标治疗手段或心脏移植的过渡治疗方法。LVAD植入术常导致主动脉瓣关闭不全（AI），这需要进行主动脉瓣修复。然而，严重急性AI对药物治疗反应不佳，再次手术对患者意味着更高的风险；LVAD引起的AI最有效的治疗策略仍需进一步探索。在本报告中，我们介绍了中国首例新发严重LVAD引起的AI病例，该患者接受了经导管主动脉瓣置换术（TAVR），功能能力和症状得到显著改善，且手术风险较低。
一名55岁男性患者，扩张型心肌病诊断14年。药物治疗效果逐渐恶化，1年前植入LVAD（HeartCon）。患者主诉间歇性胸闷1周，入院前2天加重。超声心动图检查发现新发严重LVAD引起的AI。采用自膨胀式支架瓣膜（TAV30，Vitaflow Liberty）进行TAVR。几分钟内，患者症状缓解，胸闷迅速消失，生命体征稳定。出院前，人工瓣膜位置固定，无关闭不全或血栓附着，左心室射血分数（LVEF）为35%。患者住院38天，门诊随访，至2023年6月19日病情稳定。
对于发生严重AI的LVAD患者，TAVR可能是恢复射血分数的一种有效、安全且侵入性较小的方法。
