Left ventricular assist device in pregnancy: Case report and review of the literature

Abstract

Left ventricular assist devices have emerged as a safe and effective therapy for end‐stage heart failure patients. However, little is known about the safety of these devices during pregnancy. We describe a 23‐year‐old woman who received a left ventricular device for nonischemic cardiomyopathy of uncertain origin. She became pregnant approximately 1 year later. With close monitoring of her hemodynamic parameters, she was able to achieve a gestational age of 34 weeks, at which time she delivered a healthy male infant by cesarean delivery. Pregnancies in women with left ventricular assist devices may be successful, but remain medically challenging and complex pregnancies. Close multidisciplinary involvement and frequent assessment of device parameters during pregnancy is warranted.

Maternal Outcomes in Women with Peripartum Cardiomyopathy versus Age and Race-Matched Peers in an Urban US Community

“…Notably, two women with LVAD developed major vaginal bleeding, possibly due to the combination of anticoagulation and acquired von Willebrand deficiency, which has been observed with continuous flow pumps [ 25 ]. This observation, in addition to reports of pregnancies carried out by women with LVADs, emphasizes the importance of gynecologic and contraceptive care in this group [ 26 ]. Consultation with obstetrics and gynecologists should be part of the routine LVAD evaluation for individuals who could become pregnant.…”

Management of pregnancy in left ventricular assist device and heart transplant recipients: a concise review

“…Pregnancy in an LVAD patient should be considered a contraindication due to hemodynamic alterations that can worsen right or biventricular heart failure, increased prothrombotic risk that can predispose to pump thrombosis, challenges with anticoagulation management and preterm labor [5]. Limited case series on pregnancy outcomes in an LVAD patient have been published [10,[48][49][50][51][52].…”

Pumping for Two: Pregnancy in Patients Supported With a Left Ventricular Assist Device

“…Heart failure (HF) is a common and growing disease in the United States (US), and women represent one-third of the HF population in the United States. [1][2][3][4] Left ventricular assist devices (LVADs) are a proven option for patients with advanced HF regardless of their age, sex, or indication (bridge to transplant or destination therapy). 5,24 According to the Interagency Registry for Mechanical Circulatory Support, 5,766 females (21.6%) had an LVAD implanted between 2011 and 2020, 6 and 1,288 women of age 49 years or younger had an LVAD implanted between 2008 and 2017.…”

“…5,24 According to the Interagency Registry for Mechanical Circulatory Support, 5,766 females (21.6%) had an LVAD implanted between 2011 and 2020, 6 and 1,288 women of age 49 years or younger had an LVAD implanted between 2008 and 2017. 3,[7][8][9] Notably, women on LVAD support are not included in current cardio-obstetric risk assessment scores. The modified World Health Organization (WHO) classification of maternal risk in patients with cardiovascular disease considering pregnancy uses a scoring system to evaluate the maternal mortality risk but is lacking information about women on LVAD support.…”

“…11 Females of reproductive age living with an LVAD are informed of the relative contraindication to pregnancy and are instructed to use reliable birth control. 3,5,8,11 This restriction is driven by consideration of both patient-related and LVAD-related factors (Figure 1). Patient-related factors include the hemodynamic stress induced by pregnancy, most importantly increased circulating volume, and an increased risk of right ventricular (RV) failure during delivery.…”