Authors

• Jozica Šikić — University Hospital “Sveti Duh”, Zagreb, Croatia — ORCID: 0000-0003-4488-0559
• Željko Sutlić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6926-9436
• Boris Starčević — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-3090-2772
• Mira Stipčević — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-4351-1102
• Mislav Planinc — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-9833-832X
• Sandra Jakšić Jurinjak — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-7349-6137
• Mario Udovičić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-9912-2179
• Mario Sičaja — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-0773-4720
• Robert Blažeković — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-7125-361X
• Dario Gulin — University Hospital “Sveti Duh”, Zagreb, Croatia — ORCID: 0000-0001-8502-7816

Keywords

heart failure, dilated cardiomyopathy, left ventricular assist device

DOI

Full Text

We present a case of Heart Mate 3 (HM 3) (1) explant after recovery of heart function eight months after implantation. Our patient is 60-year-old man with left side heart failure symptoms since September 2014. At the time he had atrial fibrillation and no other comorbidities. Initial echocardiographic finding was severe left ventricular impairment (left ventricular diastolic diameter - LVEDD 6.4 cm; reduced left ventricular ejection fraction - LVEF 20%). Initial coronarography exposed non-significant left anterior descending (LAD) artery stenosis. Despite optimal medicamentous treatment the patient suffered from repetitive non sustained ventricular tachycardias and had intracardiac defibrillator implanted in June 2015. Persistent left ventricular failure required implantation of the left ventricular assisted device - LVAD. The patient was followed during monthly external consultation, including device inspection, clinical examination and transthoracic echocardiography. Follow-up revealed clinical improvement with recovery of myocardial activity at echocardiography. On postoperative month 7, the echocardiography confirmed ventricular function improvement with an LVEF 50-55%. These led to the decision to remove the assist device. The weaning protocol included in-hospital evaluation consisting of echocardiography and hemodynamic measurements. Testing of cardiac function was performed under regular pump support (step 1), minimal LVAD support (step 2) and pump stop with balloon occlusion of outflow graft (step 3). Step 1 was performed one month prior to explantation (LVEF 50%, LVEDD 5.2 cm, VO2 19 ml/min/kg, PCWP 14 mmHg). Step 2 was preformed 2 days prior to explantation (LVEF 50%, LVEDD 5.4 cm, VO2 18 ml/min/kg, PCWP 15 mmHg). The final 3rd step was performed in the hybrid operating theatre with pump stop and balloon occlusion of outflow graft. After confirming preserved left ventricular function with TEE and hemodynamic measurements (preserved LVEF, CO 4.3-5.0 L/min, PCWP 14 mmHg, SVO2 80%) final decision was made to proceed with explantation immediately thereafter. The patient fully recovered after surgery. His postoperative echocardiography showed normal ejection fraction, with no heart cavities dilatation. Patient has been discharged 20 days after HM 3 explant in a good condition.

Literature

1. Dandel M, Weng Y, Siniawski H, Potapov E, Lehmkuhl HB, Hetzer R. Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices. Circulation. 2005;112(9) Suppl:I37–45. https://doi.org/10.1161/CIRCULATIONAHA.104.525352