Fu Hsun-Yi, Lou Weng-Kin, Chou Heng-Wen, Chen Yih-Sharng
Department of Cardiovascular Surgery, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan.
Department of Cardiovascular Center, Cathay General Hospital, No. 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City 106438, Taiwan.
Eur Heart J Case Rep. 2025 May 6;9(5):ytaf225. doi: 10.1093/ehjcr/ytaf225. eCollection 2025 May.
A small left ventricular cavity is one of the major limitations of HeartMate 3 implantation. Therefore, innovations in implantation techniques are required to expand the use of HeartMate 3, the only durable ventricular assist device approved by the US Food and Drug Administration for use in adults.
A 65-year-old male was diagnosed with multiple myeloma (MM) and cardiac amyloidosis. Guideline-directed medical therapy was used to treat heart failure secondary to restrictive cardiomyopathy with a small left ventricle (LV). However, after three chemotherapy courses for MM, the patient developed refractory acute decompensated heart failure. He underwent urgent HeartMate 3 implantation as a bridge to chemotherapy. We adopted the left atrium-to-aorta configuration for HeartMate 3 implantation and performed trans-septal left atrial cannulation using a modified Intergard Woven vascular graft. After discharge, the patient resumed chemotherapy on post-operative day 172 and achieved complete response on post-operative day 259. At the time of writing this report, he has been supported with HeartMate 3 for 36 months, and no major adverse events have been recorded.
In most reports of trans-septal left atrial cannulation for durable ventricular assist device implantation, a 20-mm ringed Gore-Tex graft was used as the interposition conduit. Some technical difficulties with this graft have been described. Thus, we decided to modify the Intergard Woven graft as the interposition conduit. The favourable outcome in our patient could suggest the potential of extended support with the left atrium-to-aorta configuration of HeartMate 3 for patients with a small LV.
左心室腔较小是植入HeartMate 3的主要限制因素之一。因此，需要创新植入技术以扩大HeartMate 3的使用范围，HeartMate 3是美国食品药品监督管理局批准用于成人的唯一耐用型心室辅助装置。
一名65岁男性被诊断为多发性骨髓瘤（MM）和心脏淀粉样变性。采用指南指导的药物治疗来治疗继发于限制性心肌病且左心室较小的心力衰竭。然而，在接受了三个疗程的MM化疗后，患者出现了难治性急性失代偿性心力衰竭。他接受了紧急HeartMate 3植入作为化疗的桥梁。我们采用左心房至主动脉配置进行HeartMate 3植入，并使用改良的Intergard编织血管移植物进行经房间隔左心房插管。出院后，患者在术后第172天恢复化疗，并在术后第259天达到完全缓解。在撰写本报告时，他已接受HeartMate 3支持36个月，未记录到重大不良事件。
在大多数关于植入耐用型心室辅助装置的经房间隔左心房插管的报告中，使用了内径20毫米的带环Gore-Tex移植物作为介入导管。已描述了该移植物存在的一些技术难题。因此，我们决定将Intergard编织移植物改良为介入导管。我们患者的良好结果可能表明，对于左心室较小的患者，采用HeartMate 3的左心房至主动脉配置进行长期支持具有潜力。
