CONGRESS ABSTRACT

Introduction: This case study focuses on the many facets of therapies the patient required. The medical history begins with a severe primary dilated cardiomyopathy (DCM) caused by drug abuse. The DCM required the implantation of an intracavitary cardiac resynchronization defibrillator (CRT-D). After regaining LVEF and cardiac contractility, the patient encountered his first obstacle: severe endocarditis, requiring removal of the leads and generator. After treatment with antibiotics, the patient was protected from fatal arrhythmic events with the implantation of a subcutaneous cardioverter-defibrillator (S-ICD). This reduces the risk of infection, but it did not allow for cardiac resynchronization. Consequently, the left ventricle dilated again, along with the mitral annulus, worsening the failure to a severe degree. Endovascular implantation of a Mitraclip was necessary, which reduced respiratory failure and obstruction. However, this did not last long, and the patient was urgently admitted to intensive care for severe pulmonary edema. Materials and Methods: We present the clinical history of a 47-year-old man with severe primary dilated cardiomyopathy secondary to substance abuse. Discussion: The man's heart was severely deteriorated, not only due to the disease but also due to all the previous surgeries. An Impella was placed to support the patient's hemodynamics and he was placed on the emergency regional transplant list, but his heart failed, so a Total Artificial Heart (TAH), the CARMAT, was implanted. The patient underwent surgery, and the postoperative course appeared to be good, although his hemoglobin levels were difficult to recover. The sternal wound began to show signs of leakage, including blood, and so he was placed on VacTherapy, which partially resolved the problem but also worsened it, as the vacuum suction drew more and more blood from the wound. A CT angiogram revealed the diagnosis: "an anastomosis between the Carmat and the ascending aorta had failed," and the patient, already infected, had a high risk of mortality from repeat surgery. Once again added to the national emergency transplant list, a donor was found a few days later, and the patient received the necessary care for a heart transplant. The patient was discharged 10 days after surgery. Conclusion: This case highlights the extreme complexity of management and the sequence of possible therapeutic strategies, from implantable defibrillator to TAH to transplant.