title: Off-pump exchange of short-term percutaneous ventricular assist device (VAD) to long-term implantable VAD in severe coagulopathy and multi-organ failure.
abstract: Ventricular support in patients with end-stage heart failure can be achieved using intracorporeal left ventricular assist device (LVAD) or percutaneous ventricular assist device (pVAD) systems. Multiple efforts have been made to minimize procedure-associated complications. We present a case report of an off-pump insertion of a MicroMed DeBakey VAD after Tandem Heart support using a previous sternotomy incision. A 47-year-old woman with end-stage heart failure after coronary artery bypass graft revascularization was admitted for pharmacologic treatment. She developed multi-organ failure and a severe coagulopathy with thromboembolic complications. Heparin-induced thrombocytopenia (HIT) was suspected. A percutaneous Tandem Heart was placed, the patient's condition stabilized, and finally a MicroMed DeBakey Child VAD was implanted off-pump, re-opening a previous sternotomy incision. To avoid the need for heparinization in the light of HIT and severe coagulopathy, the LVAD implantation was performed under Tandem Heart support without cardiopulmonary bypass. The patient has been anti-coagulated with angiomax ever since. Critically ill patients with end-stage heart disease, multi-organ failure, severe coagulopathy and a previous median sternotomy can be bridged from a Tandem Heart to MicroMed DeBakey VAD without cardiopulmonary bypass using the previous incision, provided there are few adhesions and stable hemodynamic conditions.
authors.affiliation: M.E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030-2707, USA.
authors.forename: Jonas
authors.initials: J
authors.lastname: Busch
authors.forename: Zbiguiew
authors.initials: Z
authors.lastname: Wojciechowski
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
mesh_terms: D002315:Cardiopulmonary Bypass; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006493:Heparin