Postocardiotomy Failure after Ross Operation: Implantation of Intravascular Flow Pump through Pulmonary Autograft

Abstract

We report a case of a patient with severe aortic stenosis, who underwent replacement of the aortic valve as a Ross procedure. Postoperatively the patient suffered postcardiotomy failure. Despite prolonged reperfusion and other methods of circulatory support, the patient could not be weaned from cardiopulmonary bypass (CPB). Therefore, an Impella intravascular flow pump was implanted, which is technically easy and has good weaning attributes. For implantation, a vascular prosthesis was sewn to the ascending aorta and the microaxial flow pump was placed under echocardiographic guidance across the pulmonary autograft into the left ventricle. With this support, the patient could be weaned from CPB. The report evaluates the Impella microaxial hemopump as a device that is technically easy to implant with no injury to the pulmonary autograft in patients after Ross operation. Surgeons should consider the device as a short-term support in borderline indications.

Endocardial Injury During Ventricular Assistance with an Intracardiac Microaxial Pump

“…Ecocardiogram-Doppler examinations during Impella Recover ® LD support have demonstrated absence of pump induced aortic regurgitation even in patients with bioprosthetic aortic valves and pulmonary autografts [6,7]. However cases of functional mitral stenosis secondary to pump placement have been reported [8].…”