The implantation of a left ventricular assist device (LVAD) has become an essential requirement for managing patients with end-stage heart failure. However, aortic valve insufficiency is a contraindication for LVAD implantation in patients with end-stage heart failure, partly because of the decreasing efficiency of mechanical circulatory support and the eventual development of right ventricular failure. Herein, we present the first case of performing transcatheter aortic valve replacement in valve-in-ring along with LVAD implantation for the treatment of a 60-year-old male suffering from refractory heart failure due to dilated cardiomyopathy and pure aortic insufficiency in need of a new aortic bioprosthesis. A balloon-expandable bioprosthetic transcatheter heart valve was implanted into a previously sewn annulus ring into the aortic root via transaortic access. Subsequently, a centrifugal-flow LVAD was implanted. Postoperatively, the patient was in New York Heart Association Functional Class (NYHA) II with 6-min walk test of 310 m. The patient has completed 6 months of follow-up with no events. This novel and feasible surgical technique reduced the cardiopulmonary bypass time and duration of surgery. Furthermore, it avoids the risk of redo sternotomy and decreases the chances of paravalvular leakage and worsening of aortic regurgitation.
Background Ventricular assist devices are an important technological development for patients with decompensated end-stage heart failure as bridging therapy for patients awaiting heart transplantation or as destination therapy. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation. The advantage of our procedure in this case report is a significant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement. Case presentation: A 34-year-old male suffering from Marfan’s syndrome underwent an emergency aortic root replacement with a 27/30 mm St. Jude Medical Masters conducted by the Bentall-De Bono technique combined implantation veno-arterial extracorporeal membrane oxygenation (ECMO): subclavian artery – femoral vein. The patient had been on temporary extracorporeal support for 17 days. There was a progression of renal, respiratory, and heart failure in the postoperative period and echocardiography revealed a left ventricular ejection fraction of about 11%, severe mitral and tricuspid valve regurgitation. Taking into account these indicators LVAD implantation was recommended by the council of doctors. The patient resided in the ICU department for 27 days and was discharged at 45 days after LVAD implantation. Conclusions Currently, an increasing number of patients with previously implanted mechanical prostheses are in need of mechanical circulatory support. At the same time, taking into consideration the high risk of thrombosis, a mechanical prosthesis should be replaced with a biological one. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can significantly aggravate right ventricular failure and increase hospital mortality in such category of patients.
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