Beating the Odds: Successful Thrombectomy Followed By Heart Transplant in a Pediatric Ventricular Assist Device Patient

Ventricular assist devices (VADs) are increasingly used in pediatric patients with end-stage heart failure as a bridge to heart transplantation (HT). Thromboembolic stroke remains one of the most devastating complications and may jeopardize transplant candidacy. We report a 13-year-old male with dilated cardiomyopathy supported with an Impella 5.5 left VAD who developed an acute ischemic stroke due to left middle cerebral artery occlusion while waiting for transplant. He underwent emergent mechanical endovascular thrombectomy with good immediate neurological improvement. Given high panel reactive antibodies and the limited availability of a donor heart, a multidisciplinary team assessed the benefits/risks of pursuing HT in the setting of acute stroke. Following its recommendations, he underwent HT within a very short interval. The patient experienced excellent long-term neurological recovery and an uncomplicated post-transplant course. This case highlights the importance of timely multidisciplinary decision-making and demonstrates that selected pediatric patients on VAD support who develop acute ischemic stroke may successfully undergo mechanical thrombectomy without delaying immediate HT.