Redo Heart transplantation in a high-risk patient due to severe aortic
regurgitation and accompanying right ventricular failure after LVAD
implantation and temporary RVAD support
Abstract
Abstract Background: We report a 62-year-old patient
who received redo-orthotopic Heart transplantation due to worsening
severe aortic regurgitation after 19 months of continuous flow LVAD
(cf-LVAD) and temporary RVAD support for one month. Case
Report: The patient received a heartware LVAD (HVAD) and annuloplasty
of the tricuspid valve due to end-stage heart failure (as a consequence
of dilated cardiomyopathy) and severe tricuspid regurgitation in
addition to right-sided ECMO implantation. Postoperatively due to the
inability to wean the implanted ECMO, a temporary RVAD was implanted
after which the patient’s condition improved so that it had been
explanted later and the patient was discharged after nine-month. In
immediate post-operative echo, minimal aortic regurgitation was noted
but in the follow-up transthoracic echocardiograms, there was a gradual
increase in the severity of aortic regurgitation with worsening both
right and left ventricular functions. TAVI was not an option due to
unfavourable anatomical issues. That’s why the patient was listed for
urgent heart transplantation, performed 19 months after the LVAD
implantation. The postoperative course was complicated due to acute
renal failure. After recompensation, dialysis, and intensive
physiotherapy, the patient could be discharged home after three months.
Conclusion: severe aortic regurgitation is a recognizable
complication after cf-LVAD implantation which in our case was managed
successfully with orthotopic heart transplantation in this high-risk
patient.