LVAD with concomitant rapid deployment valve implantation – a case report

Abstract

Background Aortic valve insufficiency can have significant hemodynamic consequences for patients with left ventricular assist devices. A circulation loop can limit systemic blood flow and increase left ventricular filling pressure. Case presentation A 64-year-old male with non-ischemic dilated cardiomyopathy underwent Heartware™ HVAD left ventricular assist device implantation with successful concomitant aortic valve replacement with an Edwards Intuity rapid deployment prosthetic valve. Conclusions The use of this rapid deployment valve may have benefits over other techniques including shorter cross clamp times during surgery, intermediate-long term durability, and preservation of aortic valve opening to allow for potential ventricular recovery. The Intuity rapid deployment valve should thus be considered a viable and suitable option for aortic insufficiency intervention during LVAD implantation.

Case report: A novel surgical technique for rapid valve-in-ring implantation into the native aortic annulus during left ventricular assist device implantation

“…Rapid deployment (RD)-AVR and TAVR have a shorter cross-clamping time and an overall procedural time, which minimizes the risk of intraoperative myocardial ischemia ( 5 , 14 , 15 ). Rahmanian et al examined 163 patients undergoing RD-AVR and reported the mean cross-clamping and cardiopulmonary times as 55 ± 23 and 88 ± 38 min respectively, which were relatively lesser than those of the control group (77 ± 22 and 105 ± 38 min), respectively, whereas in-hospital mortality rates of both the RD-AVR and control groups were similar [1.8%, ( n = 3/163); p = 1.000] ( 16 ).…”

“…Their key findings were as follows: (i) reduced cross-clamping (73.8 ± 37.5 and 107 ± 14.9 min) and procedural times (3.4 ± 1.0 and 3.7 ± 0.5 h); (ii) higher rates of new permanent pacemaker implantation leading to longer hospital stay in the RD-AVR group (∼7%); and (iii) similar rates of early myocardial infarction, stroke, and early mortality in both groups ( 17 ). Holloway et al performed RD-AVR using a 23-mm Edwards INTUITY valve (Edwards Lifesciences, Irvine, CA, United States) in an AI patient undergoing concomitant LVAD implantation ( 14 ). In the case-series reported by Gangahanamaiah and Marasco ( 18 ), RD-AVR was performed using the Perceval valve (LivaNova, London, United Kingdom).…”