Percutaneous Decommissioning of Left Ventricular Assist Device

Percutaneous Decommissioning of a Left Ventricular Assist Device in a Patient With Myocardial Recovery

“… 4 Occlusion of the outflow graft, necessary to prevent torrential regurgitation from the aorta to the left ventricle through the retained device once stopped, can be performed with minimally invasive surgical ligation or percutaneously. Percutaneous occlusion, first described by Zeigler et al 5 and subsequently in case reports and series, 6 , 7 , 8 , 9 , 10 is most commonly performed using the Amplatzer Vascular Plug II device (Abbott), although use of a left atrial appendage occluder device has also been described. 11 …”

Ventricular assist device–promoted recovery and technical aspects of explant

“…Temporary anticoagulation 54 , 58 , 59 and dual- and single-antiplatelet therapy have been described. 52 , 60 It appears that the need for medical therapy in general (ie, including anticoagulation or antiplatelet therapy) is best tailored to the individual patient. 10 …”

Reply: Death is sad, but no one's bad to stop a VAD

“…Neither Entwistle and Fenton 2 nor Fischkoff and colleagues 2 mention an important alternative possibility for decommissioning a cfVAD, namely, blocking retrograde flow through the device. Transcutaneous insertion of an obstructive plug in the conduit 4 or ligation of the conduit through a small thoracotomy incision 5 can prevent backflow, placing the patient in the same clinical situation he was in before the cfVAD was implanted, thus allowing him to die as a result of heart failure, as he wishes, without AI-EP. Obstructing backflow obviates all the ethical issues Entwistle and Fenton 2 raise.…”