RESUMO
INTRODUCTION: The planned use of a temporary right ventricular assist device (RVAD) at the time of left ventricular assist device (LVAD) implantation may prevent the need for a permanent biventricular assist device (BiVAD). Herein we describe our RVAD weaning protocol that was effectively employed in 4 patients to prevent the need for permanent BiVAD. METHODS: Four patients in refractory cardiogenic shock underwent planned RVAD insertion during LVAD implantation due to severely depressed right ventricular function with dilation preoperatively. A standardized RVAD weaning protocol was employed in these 4 patients in preparation for decannulation. RESULTS: Temporary RVADs were successfully placed in all 4 patients at the time of LVAD implantation. All patients survived to RVAD decannulation and discharge and were alive at the time of most recent follow-up (range, 528-742 days post-RVAD decannulation). CONCLUSION: Planned implantation of a temporary RVAD in high risk patients may avoid the need for biventricular mechanical support in the future.
Assuntos
Ventrículos do Coração/cirurgia , Coração Auxiliar , Choque Cardiogênico/cirurgia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adulto , Ecocardiografia Transesofagiana , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/diagnósticoRESUMO
Despite increasing use of left ventricular devices for the surgical treatment of heart failure, there is limited experience with implantation of devices in the setting of challenging left apical anatomy. We report the case of a 68-year-old man with a chronic post-infarction calcified apical pseudoaneurysm, who underwent pseudoaneurysmectomy, ventricular myoplasty, and left ventricular assist device implantation. A review of the literature and operative strategies are presented.
Assuntos
Falso Aneurisma/cirurgia , Procedimentos Cirúrgicos Cardíacos , Aneurisma Cardíaco/cirurgia , Insuficiência Cardíaca/terapia , Ruptura Cardíaca Pós-Infarto/cirurgia , Coração Auxiliar , Implantação de Prótese/instrumentação , Função Ventricular Esquerda , Idoso , Falso Aneurisma/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We describe a case of catheter-based embolization and deactivation of a left ventricular assist device using an Amplatzer plug for a patient demonstrating myocardial recovery after diagnosis of nonischemic cardiomyopathy. This procedure can provide a minimally invasive, low morbidity solution for patients wishing to be separated from left ventricular assist device support who want to avoid invasive surgery for device removal.