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.