39
Year Old Acute Myocardial Infarction Patient Recovers
After 4 Days of BVS 5000 Support
A 39 year-old male was admitted to the emergency room
of a local community hospital after experiencing chest
pain and becoming unconscious. The patient was defibrillated
multiple times for ventricular fibrillation without success.
After intubation and initiation of thrombolytic therapy
the patient was transported via ambulance to a regional
cardiac center. A cardiac catheterization was performed,
revealing 100% occlusion of the proximal Left Anterior
Decending coronary artery. The patient remained unstable
in cardiogenic shock and was taken to the opertaing room
emergently for implantation of an ABIOMED BVS® 5000
LVAD. The patient stabilized postoperatively and began
to show signs of myocardial recovery on post OP day three.
On post OP day 4 the LVAD was explanted. The patient was
discharged home post Op day11 and has returned to work.
History
A 39 year-old male male was admitted to the emergency
room of a local community hospital after experiencing
chest pain and becoming unconscious. He was defibrillated
several times for Ventricular FIbrillation, intubated,
and treated with thrombolytic therapy without success
The patient was transported via ambulance directly
to the cath lab of a large regional cardiac center.
Cardiac catheterization revealed a 100% occlusion
of the proximal LAD, EF of 10%, CO of 2.6, CI of 1.2
with a LVEDP of 35, PAP of 50/30, and a CVP of 25.
The patient continued to have refractory VF and VT
despite complete revascularization with angioplasty
of the proximal LAD. Post angioplasty the patient
had a CO of 2.2, CI of 1.0, moderate pulmonary hypertension,
LVEDP of 40, and an EF of 10%. A bulging paradoxical
septum into the RV caused acute RV dilatation and
dysfunction. The patient remained unstable, and in
cardiogenic shock despite maximal therapy.
The patient was taken to the OR emergency for implantation
of an ABIOMED® BVS® 5000i LVAD. Inflow to
the LVAD was established using a 36 Fr. malleable
cannula inserted into the right superior pulmonary
vein. A 12mm Dacron® graft was anastomosed to
the ascending aorta for return flow to the aorta.
Flow from the BVS LVAD was 5.3 liters/min. upon initiation
of support. Post BVS LVAD, TEE revealed a now functional
RV with low dose inotropic support. No blood transfusions
were necessary except for autologous blood.
Post-Operative
Postoperatively, the patient remained stable with
good end organ function and was neurologically intact.
He began to show signs of ventricular recovery and
on POD 3, at which time a TEE revealed an EF of 35%
with PAP of 25/15, CO of 5.1, CI of 2.4. The LVAD
was explanted on POD 4, and on POD 10 an AICD was
placed. The patient was discharged home POD 11 and
has returned to work.
Patient Data
AMI complicated by cardiogenic shock
Type of Support: LVAD
Age: 39 Gender: M Wt: 91 kg Ht: 183 cm BSA: 2.1 m2
Surgical Data
Procedure: Implantation of ABIOMED LVAD
Total CPB time: Procedure performed without CPB
IABP prior to LVAD: Yes
Cannulation sites: RSPV 36 Fr. atrial; Ascending Aorta
12mm Dacron
Patient Hemodynamics
|
Pre BVS Implant |
On BVS Support |
BVS Explanted |
BP mmHg
|
120/84 |
97/65 |
117/57 |
CVP mmHg
|
25 |
13 |
12 |
PAP mmHg
|
50/30 |
25/13 |
34/18 |
CO L/min/m2
|
2.2 |
5.1 |
8.2 |
CI L/min/m2
|
1.2 |
2.4 |
3.9 |
| EF% |
10 |
35 |
40 |
Inotropic Support
|
Pre BVS Implant |
On BVS Support |
BVS Explanted |
Lidocaine mg/min
|
120/84 |
97/65 |
117/57 |
NTG mg/min
|
25 |
13 |
12 |
Epinepherine mcg/min
|
50/30 |
25/13 |
34/18 |
Levophed mcg/min
|
2.2 |
5.1 |
8.2 |
Primacor mcg/min
|
1.2 |
2.4 |
3.9 |
Amiodarone mg/min
|
10 |
35 |
40 |
Organ Function
|
Pre BVS Implant |
On BVS Support |
BVS Explanted |
Liver:
|
|
|
|
AST U/m
|
71 |
244 |
97 |
ALT U/ml
|
25 |
89 |
38 |
Kidney:
|
|
|
|
BUN mg/dl
|
9 |
7 |
11 |
Creatinine mg/dl
|
1.3 |
0.8 |
0.8 |
Anticoagulation Therapy
Titrated heparin initiation time: 9 hours post LVAD
implantation
Average chest tube drainage 2 hours prior to heparin
initiation was 70cc
ACT range 179-235 seconds
|
