Patient
on ABIOMED BVS LVAD Receives Heart Transplant
A 31-year-old male was admitted to a local community hospital
emergency room with chest pain. He was taken to the cardiac
catheterization laboratory where a stent was placed. The
patient was treated with aspirin, Plavix and Reopro. An
echocardiogram was and chest x ray were performed. The
patient was diagnosed with heart failure and discharged
to home. Two weeks later, the patient was readmitted to
the emergency room with chest pain. He was taken to the
cardiac catheterization laboratory where 100% occlusion
of the previously placed stent was diagnosed. Immediately
after diagnosis, the patient had cardiac arrest and was
taken to the operating room for coronary artery bypass.
In addition to the bypass surgery, the patient had an
ABIOMED BVS5000 LVAD implanted. The patient was then transported
via helicopter to a regional heart transplant center.
The decision was then made to transition the patient to
a longer term ventricular assist device and place the
patient on the waiting list for a heart transplant. Two
months later the patient received a heart transplant.
History
A 31-year-old male was admitted to a local communty
hospital emergency room with substernal chest pain.
He was taken to the catheterization laboratory.where
a stent was placed in the LAD. The patient was treated
with aspirin, Plavix and Reopro. a an anterior apical
hypokinesis with possible apical thrombus and moderate
mital regurgitation. Chest x-ray was consistent with
congestive heart failure. The patient was discharged
home. Two weeks later, the patient was readmitted
to the emergency room with chest pain. He was taken
to the catheterization laboratory where 100% occulsion
of the stent was diagnosed. Immediately after diagnosis,
the patient arrested, CPR initiated, and was the patient
was taken to the OR.
Operative Summary
Coronary artery bypass graft x 3 involving the saphenous
vein to the obtuse marginal one, obtuse marginal two
and the left anterior descending arteries were performed.
Unable to wean from CPB, the Abiomed LVAD was implanted
with assisted C.O of 5.5 L/minute. A 36 Fr. atria
cannula was implanted into the right superior pulmonary
vein with a 12mm arterial cannula anastomosed to the
ascending aorta.
Post-operative Summary
On POD 1, the patient was transported via helicopter
to a regional transplant center for further evaluation.
Upon arrival, an echocardiogram revealed a large laminated
thrombus, at least 50% of the left ventricle was found
to be severe with an EF of 5%, a severe right ventricle
and a PFO. Due to the patient's severity, he
was immediately staged to a long-term implantable
LVAS with repair of the PFO. His postoperative course
was complicated by bleeding requiring a return to
the operating room for clot removal, VF requiring
DCC, amiodarone for treatment for AF, respiratory
distress requiring prolonged intubation, and thrombocytopenia.
Two months later the patient was taken to the O.R
for removal of the LVAS and OHT with bicaval anastomosis.
The post OHT course was uncomplicated.
Patient Data
Indication: Post-cardiotomy cardiogenic shock
Type of Support: LVAD
Age: 31 Gender: M Wt: 82.4 kg Ht: 191 cm BSA: 2.11
m2
Surgical Data
Procedure: CABG x 3
Total CPB time: 6 hours 46 minutes
Attempts to wean off CPB: 2
Time between second CPB and LVAD: 35 minutes
IABP prior to LVAD: Yes
Cannulation sites: Right SPV 36 Fr. atrial; Ascending
Aorta 12mm arterial
Patient Hemodynamics
|
Pre BVS Implant |
On BVS Support |
BVS Explanted |
| MAP: |
92 |
84 |
85 |
| CVP: |
22 |
17 |
3 |
| PAP: |
58/36 |
20/12 |
21/13 |
| CO |
Not obtained |
5.5 |
6.1 |
| CI |
Not obtained |
2.5 |
2.9 |
| EF% |
5 |
5 |
Normal |
Inotropic Support
|
Pre BVS Implant |
On BVS Support |
BVS Explanted |
| Dopamine mcg/kg/min |
5 |
Off |
Off |
Nitroglycerine mcg/min
|
66 |
Off |
Off |
Dobutamine mcg/kg/min
|
Off |
4.5 |
Off |
Milrinone mcg/kg/min
|
0.5 |
Off |
Off |
Organ Function
|
Pre BVS Implant |
On BVS Support |
BVS Explanted |
Liver:
|
|
|
|
AST U/m
|
Not obtained |
192 |
14 |
ALT U/ml
|
Not obtained |
44 |
17 |
Kidney:
|
|
|
|
BUN mg/dl
|
15 |
15 |
8 |
Creatinine mg/dl
|
1.1 |
0.9 |
1.2 |
Anticoagulation Therapy
Titrated Heparin Initiation time: 6 hours 30 minutes
post BVS LVAD implant
Average chest tube drainage upon heparin initiation:
40 cc
ACT range: 136 &8211; 197 seconds
|
