Left Ventricular Assist Device Implantation and Concomitant Dor Procedure: a Single Center Experience

Abstract

Objective Left ventricular assist device (LVAD) implantation with concomitant Dor plasty is only reported anecdotally. We herein aimed to describe our experience with LVAD and concomitant Dor procedures and describe long-term outcomes of this special subset of heart failure patients. Methods Between January/2010 and December/2018, 144 patients received LVAD therapy at our institution. Of those, five patients (80% male, 60.4±7.2 years) presented with an apical aneurysm and received concomitant Dor plasty. Apical aneurysms presented diameter between 75 and 98 mm, with one impending rupture. Results Procedural success was achieved in all patients. No unplanned right ventricular assist device implantation occurred. Furthermore, no acute 30-day mortality was seen. In follow-up, one patient was lost due to intentional disconnection of the driveline. One patient underwent heart transplantation on postoperative day 630. The remaining three patients are still on device with sufficient flow; pump thromboses were successfully managed by lysis therapy in one patient. Conclusion LVAD implantation with concomitant Dor procedure is feasible, safe, and occasionally performed in patients with ischemic cardiomyopathy. Major advantages are prevention of thromboembolism and facilitation of LVAD placement by improving pump stability and warranting midventricular, coaxial alignment of the inflow cannula. In long-term follow-up, no adverse event associated with Dor plasty was observed.

HeartMate 3 Left Ventricular Assist Device Implant and Repair of a Left Ventricular Pseudoaneurysm

“…A limited number of reports describe apical LV aneurysm repair during LVAD implantation, describing the placement of the inflow cannula at the aneurysm repair site. [1][2][3] When considering the feasibility of concomitant LVAD and LV reconstruction, one must consider the following: (1) location of LV pseudoaneurysm/ aneurysm, (2) LV dimensions, and (3) right ventricular function. Our case is unique in that the inferior-wall LV pseudoaneurysm did not involve the true apex, so implantation of the LVAD inflow cannula through the patch was not ideal.…”

“…HeartMate 3 Left Ventricular Assist Device Implant and Repair of a Left Ventricular Pseudoaneurysm Aryan Meknat , MD; Manreet K. Kanwar , MD; Candice Y. Lee , MD; Masaki Tsukashita , MD, PhD H eart failure remains the most common reason for hospital admission in the United States, coinciding with the increasing number of left ventricular (LV) assist devices (LVADs). 1 Patients having an LVAD implanted often have concomitant cardiac conditions. One condition that can complicate LVAD implantation is the presence of an LV aneurysm.…”

“…Heart failure remains the most common reason for hospital admission in the United States, coinciding with the increasing number of left ventricular (LV) assist devices (LVADs). 1 Patients having an LVAD implanted often have concomitant cardiac conditions. One condition that can complicate LVAD implantation is the presence of an LV aneurysm.…”