title: Titanium Plug Closure after HeartWare Ventricular Assist Device Explantation in a 15-Year-Old Girl: First U.S. Experience.
abstract: We describe the case of a teenage girl with anthracycline-induced cardiomyopathy who received a HeartWare ventricular assist device and underwent successful device explantation after cardiac recovery. During device support, the patient's cardiac function returned to normal. Twelve months after implantation, we explanted the device via repeat median sternotomy. To close the hole in the left ventricular apex and preserve the sewing ring in case future device support is needed, we used a German-manufactured titanium plug, developed specifically for this purpose. To our knowledge, this is the first use of this plug in the United States. The patient recovered uneventfully and was discharged from the hospital on postoperative day 11. Left ventricular biopsy specimens at explantation revealed the resolution of previous degenerative sarcomeric changes. Our patient did well clinically; however, recurrent late anthracycline cardiotoxicity might subsequently cause her cardiac function to deteriorate. In this event, our use of the titanium plug to preserve the left ventricular sewing ring would enable easier device replacement than would other explantation options.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Lara
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Elias
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: McCullum
authors.forename: Susan W
authors.initials: SW
authors.lastname: Denfield
authors.forename: William J
authors.initials: WJ
authors.lastname: Dreyer
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D066126:Cardiotoxicity; D020878:Device Removal; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D020127:Recovery of Function; D013318:Stroke Volume; D053831:Surgical Fixation Devices; D014025:Titanium; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left; D058106:Wound Closure Techniques / Q000295:instrumentation*
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D014025:Titanium
keywords: Adolescent; cardiomyopathies/chemically induced; cardiovascular surgical procedures/instrumentation/methods; device removal/methods; equipment design; heart failure/therapy; heart-assist devices/utilization; recovery of function; titanium; treatment outcome