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Continuous-Flow Left Ventricular Assist Device Explantation After More Than 5 Years of Circulatory Support and Ventricular Reconditioning
Texas Heart Institute Journal ( IF 0.9 ) Pub Date : 2021-06-10 , DOI: 10.14503/thij-20-7266
George V Letsou 1 , Andrew C W Baldwin 1 , Andrew B Civitello 1 , William E Cohn 1 , O H Frazier 1
Affiliation  

Continuous-flow left ventricular assist devices have proved to be effective, durable, life-saving tools in patients with end-stage heart failure. However, because of the risks associated with mechanical circulatory support (including stroke, infection, gastrointestinal bleeding, and device malfunction), the optimal goal of device therapy is myocardial recovery and device removal. Ventricular reconditioning and pump explantation after continuous-flow support have been reported; however, little is known about variables that govern the pace and degree of myocardial response in patients who experience such recovery. We describe our long-term pump-weaning strategy for a 25-year-old man who had a continuous-flow device implanted and then needed more than 5 years of support from it before developing cardiac reserve sufficient to enable pump explantation. To our knowledge, this is the longest period of uninterrupted continuous-flow device support to end in successful pump deactivation and a return to medical therapy. This case highlights the importance of actively and persistently pursuing a device-weaning strategy in all patients who need left ventricular assist device therapy.



中文翻译:

经过 5 年多的循环支持和心室修复后的连续流左心室辅助装置移植

连续流左心室辅助装置已被证明是治疗终末期心力衰竭患者的有效、耐用、挽救生命的工具。然而,由于与机械循环支持相关的风险(包括中风、感染、胃肠道出血和设备故障),设备治疗的最佳目标是心肌恢复和设备移除。已有报道在连续流支持后进行心室修复和泵移植;然而,对于控制经历这种恢复的患者的心肌反应速度和程度的变量知之甚少。我们描述了一位 25 岁男性的长期停泵策略,他植入了连续流装置,然后需要 5 年以上的支持,然后才能发展出足以进行泵移植的心脏储备。据我们所知,这是最长的不间断连续流设备支持期,以成功停用泵并返回医疗治疗结束。该病例强调了在所有需要左心室辅助装置治疗的患者中积极和持续地实施装置撤机策略的重要性。

更新日期:2021-06-11
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