Case Description
This study was approved by our institutional review board
(MOD18120143-003, approved 3/9/2020), and written consent was obtained.
A 60-year-old male with history of nonischemic cardiomyopathy with left
ventricular ejection fraction of 20% was admitted to the hospital with
recurrent ventricular tachycardia. He had undergone three unsuccessful
ablation procedures and had also failed multiple outpatient
anti-arrhythmic pharmacotherapies. While inpatient, he was maintained on
a continuous intravenous infusion of lidocaine. Initially, he was listed
as Status 3E, and remained inpatient awaiting a heart offer for over
four months. Eventually, he was upgraded to Status 2E due to increased
burden of ventricular tachycardia. On post-upgrade day 16, he received a
donor offer.
The donor was a 40-year-old male who underwent brain death pronouncement
after sustaining blunt head trauma. On echocardiography, the heart had
good biventricular function. Due to the donor’s age, left coronary
catheterization was performed which revealed an anomalous origin of the
left coronary artery (LCA). The LCA and right coronary artery arose from
a single ostium within the right sinus of Valsalva (Figure A). Chest
computed tomography demonstrated a retro-aortic course of the LCA
(Figure B). A discussion was held among the heart failure cardiology and
cardiac surgery team. Because the LCA did not appear to have an
inter-arterial or other malignant course, the decision was made to
pursue transplantation. A heart team was sent to the donor facility, and
the heart was accepted and later transplanted (Video). Transplantation
was performed using our usual implantation technique without
modification, beginning with the left atrial cuff anastomosis followed
by the aortic anastomosis.
The patient did well post-transplant. His hospital course was prolonged
primarily due to pretransplant physical conditioning, having been
hospitalized for four months prior to transplant. On posttransplant day
36, he was discharged to a rehabilitation facility, and was discharged
home 24 days later.