Key result
Mini-thoracotomy with hypothermic arrest enables successful retrieval and valve-in-valve TAVR in LVAD-associated AI.
Why the study?
Management of severe aortic insufficiency in patients with LVAD is complicated by procedural challenges and device-related complications requiring innovative surgical approaches.
Case Report (n=1)
A mini-thoracotomy approach with deep hypothermic cardiac arrest can be a successful rescue strategy for TAVR valve dislodgment and LVAD inflow cannula occlusion in patients with LVAD-associated severe aortic insufficiency.
Answers are grounded in this paper and cite their sources.
May offer a bailout option in rare LVAD-TAVR complications; hypothesis-generating and should not yet change practice.
We present the patient with severe aortic insufficiency (AI) 5 years post left ventricular assist device (LVAD) implantation. His management was complicated with unsuccessful percutaneous aortic valve closure attempt, transcatheter aortic valve replacement (TAVR) implantation with a severe paravalvular leak, eventual valve dislodgment into the left ventricle (LV), and LVAD inflow cannula occlusion. We utilized a mini-thoracotomy approach to successfully retrieve the dislodged valve through the LV apex while deploying a valve-in-valve TAVR under direct visualization and deep hypothermic cardiac arrest. This case can serve as an example of the serious pitfalls and potential resolution strategies when treating LVAD-associated AI.
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Bjelic et al. (2020) conducted a case report in Severe aortic insufficiency post left ventricular assist device implantation (n=1). Transcatheter aortic valve replacement via mini-thoracotomy approach with deep hypothermic cardiac arrest was evaluated on Successful retrieval of dislodged valve and deployment of valve-in-valve TAVR. A mini-thoracotomy approach with deep hypothermic cardiac arrest successfully retrieved a dislodged TAVR valve and allowed deployment of a valve-in-valve TAVR in a patient with LVAD-associated AI.
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