Case study demonstrating intra-aortic balloon pump bridged to left ventricular assist device heart failure complicated by right ventricular assist device implantation

SESSION TITLE: Cardiovascular Disease Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: A 65-year-old African American woman with a history of heart failure with reduced ejection fraction, atrial fibrillation with left atrial appendage closure, severe mitral regurgitation with mitral valve repair on warfarin, hypertension, and hyperlipidemia was transferred to our facility in cardiogenic shock requiring mechanical circulatory support. CASE PRESENTATION: She initially presented with decompensated left heart failure requiring dobutamine but was not a transplant candidate because her panel reactive antibody was 100%. She was diuresed and discharged home on dobutamine and life-vest as an option to bridge to a left ventricular assist device (LVAD). She presented to an outside hospital a month later with volume overload and ventricular arrest with cardiogenic shock requiring intra-aortic balloon pump (IABP) support. She also developed acute renal failure needing continuous renal replacement therapy. She was not a strong candidate for LVAD and was transferred to our facility for both HeartMate 3 LVAD implantation and tricuspid valve repair. However, due to right ventricle (RV) dysfunction from rising central venous pressure, she required implantation of Protek Duo RVAD and increased vasopressor support, which continued through her post-op course after the IABP was removed. Her RVAD was removed on post-op day 17 after her RV pressure gradients and volume status improved with minimal dobutamine support. She was unable to wean off the ventilator and was discharged to a long-term acute care hospital with tracheostomy and PEG placement for malnutrition and dysphagia. She required antibiotics for bilateral pneumonia and sacral wounds. DISCUSSION: As demonstrated in this case, the implementation of LVAD can lead to immediate RV failure due to increased preload demands in patients predisposed to RV dysfunction. Independent risk factors predicting early post-LVAD right heart failure include female gender, IABP, mechanical ventilatory support, and RRT (1). CONCLUSIONS: It is important to recognize risk factors for acute right ventricular heart failure in patients that have had a successfully implanted LVAD. Early discussion and education in the implantation of LVAD in patients with end-stage heart failure may limit future complications. REFERENCE #1: Argiriou M, Kolokotron SM, Sakellaridis T, Argiriou O, Charitos C, Zarogoulidis P, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Tsakiridis K, Zarogoulidis K. Right heart failure post left ventricular assist device implantation. J Thorac Dis. 2014 Mar;6 Suppl 1(Suppl 1):S52-9. doi: 10.3978/j.issn.2072-1439.2013.10.26. PMID: 24672699; PMCID: PMC3966152. DISCLOSURES: No relevant relationships by moizz akhtar No relevant relationships by Hanad Bashir No relevant relationships by Ankit Bhatia