Use of a Left Ventricular Assist Device in Hypertrophic Cardiomyopathy

Abstract

Late stages of hypertrophic cardiomyopathy (HCM) result in medically refractory heart failure. Current treatments include septal myomectomy or alcohol ablation; however, not all patients are eligible for these procedures. We describe the technical aspects of implantation of a HeartMate II left ventricular assist device as a bridge to transplant therapy for a patient with HCM and end-stage heart failure. Pre- and post-operative imaging demonstrates the importance of establishing a functional inflow tract for the device.

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

“…In end-stage HFrEF, systolic function and adequate cardiac hemodynamics can be restored through MCS devices. Although the use of HFrEF MCS devices that support the pumping action of the left ventricle is not recommended in HFpEF, due to reported risks of atrial suction and intraventricular thrombosis ( 86 , 172 , 182 , 185 , 186 , 187 , 188 ), analogous solutions that are specific for HFpEF are currently under development to reduce LAP, enhance LV filling, and restore cardiac output. In this context, a variety of in silico and in vitro studies have been conducted on a number of proposed approaches to investigate their feasibility ( 22 , 175 , 176 , 177 , 178 , 179 ).…”

Systemic Atrioventricular Valve Excision and Ventricular Assist Devices in Pediatric Patients

“…Wynne and colleagues reported a patient with hypertrophic cardiomyopathy in whom CF VAD, myomectomy and resection of mitral valve attachments were required, with resultant flail mitral valve. [9] However, the patient continued to be well-supported on the device for many months, demonstrating that a CF VAD may not require a protected AVV. Others have also demonstrated CF VADs can support patients with uncorrected significant mitral regurgitation.…”

“…Various approaches to the use of VADs in small patients have been attempted, including use of spacer rings to reduce amount of inflow cannula within the heart[5], alternative cannulation sites [6,7], alteration to left ventricular cavity size by changing level of the atrioventricular valve [8] or myomectomy [9]. We proposed that, for patients in whom the ultimate goal is heart transplantation, CF VAD implantation could be facilitated by excision of the atrioventricular valve (AVV).…”

Hypertrophic Cardiomyopathy: Treatment, Risk Stratification, and Implantable Defibrillators

“…Totally, 1-7% of all transplants have HCM as the indication [36]. Left ventricular assist devices may be an option, and continuous axial flow assist therapy has shown promising results in a small series [37].…”