End-stage heart failure with multiple intracardiac thrombi: a rescue strategy.
The use of ventricular assist devices as a bridge to transplantation has become a widely used option for patients with end-stage heart failure. In contrast to total artificial hearts, ventricular assist devices support the failing heart by bypassing one or both ventricles. In certain cases (myocardial tumors, graft failure, transplant rejection, endocarditis, intracardiac thrombus formation), however, it may be advantageous to excise the heart and replace it with an artificial device. Total artificial hearts are intracorporeal devices designed for this purpose. Unfortunately, some patients are too small or are, for other reasons, ineligible for a total artificial heart. We describe the case of a 55-year-old woman who had ischemic cardiomyopathy and thrombus formation in all 4 cardiac chambers. To reduce the risk of thromboembolic events, we elected to replace her heart completely with 2 extracorporeal ventricular assist devices. The heart was excised via a median stemotomy approach, and the outflow cannulae (from device to patient) were connected to both atrial remnants. The 2 inflow cannulae (from patient to device) were anastomosed end-to-end to the aorta and the pulmonary artery, respectively. After attaining a flow of more than 5 L, the 2 extracorporeal assist devices effectively and efficiently performed the work of the native heart. Thus re-established, organ perfusion was improved by this mechanically driven circulation, as signified by an initial decrease in creatinine and blood urea nitrogen levels. The patient, however, did not recover from postoperative neurological dysfunction and died of respiratory insufficiency and multiple-organ failure on the 26th postoperative day.
Posch
Maximillian G
MG
Michael E. DeBakey Department of Surgery, Division of Transplant Surgery and Assist Devices, Baylor College of Medicine, Houston, Texas 77030, USA.
Thompson
Larry O
LO
Koerner
Michael M
MM
Akay
Mehmet H
MH
Noon
George P
GP
Loebe
Matthias
M
D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications / Q000601:surgery*
Catheter Cardiovasc Interv. 2000 Jan;49(1):91-6
10627378
Ann Thorac Surg. 2001 Mar;71(3 Suppl):S92-7; discussion S114-5
11265873
N Engl J Med. 2001 Nov 15;345(20):1435-43
11794191
Ann Thorac Surg. 2002 Aug;74(2):609-11
12173867
Int J Artif Organs. 1998 Jul;21(7):414-6
9745997
ASAIO J. 1996 Sep-Oct;42(5):M542-6
8944938
Ann Thorac Surg. 1997 Sep;64(3):861-2
9307498
Thorac Cardiovasc Surg. 1998 Apr;46(2):102-5
9618815
Am J Perinatol. 2003 Feb;20(2):91-6
12660914