Affiliation:
1. National Research Center for Cardiac Surgery
Abstract
Abstract
Background
Ventricular assist devices are an important technological development for patients with decompensated end-stage heart failure as bridging therapy for patients awaiting heart transplantation or as destination therapy. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation. The advantage of our procedure in this case report is a significant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement.
Case presentation:
A 34-year-old male suffering from Marfan’s syndrome underwent an emergency aortic root replacement with a 27/30 mm St. Jude Medical Masters conducted by the Bentall-De Bono technique combined implantation veno-arterial extracorporeal membrane oxygenation (ECMO): subclavian artery – femoral vein. The patient had been on temporary extracorporeal support for 17 days. There was a progression of renal, respiratory, and heart failure in the postoperative period and echocardiography revealed a left ventricular ejection fraction of about 11%, severe mitral and tricuspid valve regurgitation. Taking into account these indicators LVAD implantation was recommended by the council of doctors. The patient resided in the ICU department for 27 days and was discharged at 45 days after LVAD implantation.
Conclusions
Currently, an increasing number of patients with previously implanted mechanical prostheses are in need of mechanical circulatory support. At the same time, taking into consideration the high risk of thrombosis, a mechanical prosthesis should be replaced with a biological one. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can significantly aggravate right ventricular failure and increase hospital mortality in such category of patients.
Publisher
Research Square Platform LLC