Management of air embolism during HeartMate XVE exchange.
Air embolism is a rare and usually fatal complication of major cardiac surgery. We present a case in which a 45-year-old man supported by a HeartMate(R) XVE left ventricular assist device required a pump exchange due to failure of the device motor. During pump dissection, a massive amount of air entered the systemic circulation. Urgent cannulation for cardiopulmonary bypass was performed, and cardiopulmonary bypass was initiated, followed by profound hypothermia, circulatory arrest, retrograde cerebral perfusion, retrograde coronary sinus perfusion, and then barbiturate coma and steroid therapy. The HeartMate XVE left ventricular assist device was removed, and a HeartMate II was implanted. After 5 days, the patient awoke with left hemiparesis, which nearly resolved with aggressive physical therapy. Forty-four days after the pump exchange operation, the patient was discharged from the hospital with only mild left hemiparesis. Exposure of the left ventricular assist device or its external components requires careful monitoring, because air can enter the pump-particularly in a hypovolemic patient. Rapid response after massive air entry into the left ventricular assist device system, as in our patient, can result in a successful outcome.
Gregoric
Igor D
ID
Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. igregoric@heart.thi.tmc.edu
Myers
Timothy J
TJ
Kar
Biswajit
B
Loyalka
Pranav
P
Reverdin
Stephane
S
La Francesca
Saverio
S
Odegaard
Peggy
P
Gemmato
Courtney J
CJ
Frazier
O H
OH
D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004618:Embolism, Air / Q000209:etiology* / Q000601:surgery; D004868:Equipment Failure; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology