Patient
with an acute myocardial infarction and cardiogenic shock
receives heart transplant following BVS therapy
A 51-year-old female with a history of ischemic cardiomyopathy
and end-stage heart failure presented to a community hospital
in acute cardiogenic shock following Acute Myocardial
Infarction. Cardiac catheterization revealed a 90% occlusion
of the Left Main artery, and an 80% occlusion of the RCA.
An IABP was placed and the patient was taken to the operating
room the next morning for coronary artery bypass surgery.
During the operative procedure, an ABIOMED BVS 5000 LVAD
was necessary in order to wean the patient from cardio-pulmonary
bypass. After seven days on BVS support, the patient was
transported via ambulance to a regional cardiac transplant
center for further evaluation. Two days later the patient
was transitioned to a longer term cardiac assist device.
One month later the pateint received a heart transplant
and was discharged to home some time later. She has since
returned to her normal daily activities.
History
A 51-year-old female with a documented history of
ischemic cardiomyopathy and end-stage heart failure
presented to a community hospital in acute cardiogenic
shock following AMI. Cardiac catheterization revealed
a 90% Left Main lesion, and an 80% RCA lesion; LVEDP
was 46 mm Hg. An IABP was placed for stabilization
and patient was taken to the operating room in the
morning for an urgent CABG. Co-morbidities included:
hypertension, diabetes mellitus, morbid obesity, and
an active smoking history.
Operative Summary
Following induction, the patient exhibited marginal
hemodynamics with PA pressures of 70/40, systemic
pressure of 65/40, and a CI of 1.8 L/min./m2. Hemodynamics
were supported with inotropic agents. TEE revealed
LVEF of 20%. CABG x 4 was performed utilizing the
LIMA and saphenous vein. CPB was discontinued with
multiple inotropic agents and TEE showed LVEF of 35%.
After decannulation, the patient suffered hemodynamic
collapse requiring the second return onto CPB. Although
the circumflex vessel was regrafted, the third attempt
to come off CPB proved unsuccessful, despite maximal
inotropic and IABP support. An ABIOMED BVS LVAD was
placed via the right superior pulmonary vein with
a 32 Fr. Atrial Cannula, and the ascending aorta was
grafted with a 10 mm Hemashield™.
Post-Operative
After 7 days on BVS LVAD support, the patient was
transported via ambulance on to a regional cardiac
transplant center for further evaluation. Two days
later, the patient was taken to the operating room.
An echocardiogram demonstrated global left ventricular
failure and MR. The BVS LVAD served as a staging device
to the implantation of the HeartMate as a bridge to
transplant LVAS. One month later a donor heart became
available and the patient underwent orthotopic heart
transplantation without complication. The remainder
of her hospital stay was uneventful and she was discharged
home. She has resumed her daily activities with no
restrictions.
Patient Data
Indication for Use:AMI/Acute Cardiogenic Shock/ Post
Cardiotomy
Type of BVS support: LVAD, 9 day duration
Age: 51 Sex: F Weight: 96 kg BSA: 2.00 m2
Surgical Data
Surgical Procedure: CABG x 4/LIMA
Total CPB time: 175 min.
Attempts to wean CPB: 3
IABP and multiple inotropes prior to LVAD: Yes
Cannulation LVAD: Right SPV - 32 Fr. Atrial; Ascending
Aorta- 10 mm. Arterial
Patient Hemodynamics
|
Pre Implant |
On BVS Support |
| MAP: |
59 |
79 |
| RAP: |
23 |
21 |
| PAP: |
70/40 |
45/20 |
| CI: |
1.8 |
2.2 |
| EF: |
20% |
NA |
Organ Function
Liver: normal
Kidney: BUN=16, creatinine = 1.8
Anticoagulation Therapy
Initiation time: 10 hours post implant
ACT range: 180-210 sec.
|
