Prophylactic LVAD Enabling High-Risk Mitral Repair—Extending Beyond the Guidelines

Abstract

<jats:p> Both surgical and percutaneous mitral repair remain contraindicated in patients with severe degenerative mitral regurgitation (DMR) with severe left ventricular (LV) dysfunction because of inadequate LV reserve and increased LV work with a competent mitral valve. We report a 55-year-old gentleman who presented in cardiogenic shock with missed severe DMR and severe LV dysfunction, in whom we performed a high-risk mitral repair and insertion of a prophylactic CentriMag LV assist device. This innovative approach was found to be successful with significant patient improvement in both LV function and clinical symptoms with a competent mitral valve. </jats:p>

High-risk cardiac surgery: Time to explore a new paradigm

“…This concept has been used anecdotally in the setting of valvular surgery. 23,24 POTENTIAL UNLOADING TECHNOLOGIES The rationale for using a full LV unloading device in the setting of high-risk surgery is manifold: (1) It can potential reduce, spare, or allow weaning of toxic pressors that result in undesirable splanchnic and peripheral vasoconstriction 7,8 ; (2) it maintains end-organ perfusion by augmenting systemic output; (3) it allows time to metabolize inflammatory cytokines 25 and to recover from the CPB-induced mitochondrial dysfunction mitochondrial function 26 ; and (4) it allows time to assess recoverability of LV function. Three strategies based on current available technologies can be considered:…”

The hemodynamics and blood trauma in axial blood pump under different operating models

“…The prevalence of cardiovascular diseases is on the rise 2 . Cardiovascular disease and heart failure caused by it are serious diseases threatening human life 3 . However, for patients with end‐stage heart failure, drug therapy can only temporarily relieve the symptoms of heart failure but cannot prolong the survival time of patients.…”