title: Full-Support LVAD Implantation in a C-Pulse Heart Assist System Recipient with Deteriorating Chronic Heart Failure: Is It Feasible and Safe?
abstract: Heart failure is a progressive disease with limited treatment options. The C-Pulse Heart Assist System (Eden Prairie, MN) is an extravascular, diastolic counterpulsation circulatory support device for patients with refractory NHYA Class III/ambulatory class IV heart failure. It comprises a balloon-cuff which is implanted around the ascending aorta that is synchronised to inflate during ventricular diastole. The system eliminates the need for systemic anticoagulation and significantly reduces the risk of bleeding and overcomes the problem of device thrombosis. However, clinical efficacy is dependent on maintenance of residual myocardial function. We describe a case of a patient who presented with ischemic cardiomyopathy in end-stage heart failure and received the C-Pulse System. Due to deterioration in cardiac function, the system had to be upgraded to a full-support left ventricular assist device (LVAD) after 4 months. However, the aorta ascendens was short and the outflow graft of the HeartWare LVAD had to be anastomosed to the cuff balloon region of the aorta. Our experience showed in this case that the inflatable cuff action did not compromise the structural integrity of the aortic wall.
authors.affiliation: From the *Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; and †Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Bowles
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.forename: Ali
authors.initials: A
authors.lastname: Ghodsizad
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Mohite
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Patil
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
mesh_terms: D002908:Chronic Disease; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged