A novel percutaneous mechanical biventricular bridge to recovery in severe cardiac allograft rejection.
We describe the case of a 36-year-old man with acute cardiac transplant rejection bridged to recovery using simultaneous Impella 2.5 and TandemHeart percutaneous support devices. The patient underwent orthotopic cardiac transplantation 2 years earlier, and presented to our hospital with allograft failure 7 days after non-compliance with tacrolimus. Because of persistent cardiogenic shock despite intra-aortic balloon and inotropic support, we implanted an Impella 2.5 percutaneous assist device for left ventricular support. Persistent right ventricular dysfunction necessitated insertion of a TandemHeart for right ventricular support. After a course of intravenous solumedrol and anti-thymocyte globulin, both the Impella and TandemHeart devices were successfully weaned and removed. Nine months later, his left ventricular ejection fraction had stabilized from 10% to 55%.
Rajagopal
Vivek
V
Piedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia 30309, USA. vraj02@yahoo.com
Steahr
Gregg
G
Wilmer
Charles I
CI
Raval
Nirav Y
NY
D000328:Adult; D002302:Cardiac Output / Q000502:physiology; D020878:Device Removal; D006084:Graft Rejection / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D020127:Recovery of Function / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology / Q000601:surgery*