Associazione Nazionale Medici Cardiologi Ospedalieri

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CONGRESS ABSTRACT

CONGRESS ABSTRACT

APICAL-AXILLARY CONFIGURATION IN BRIDGE-TO-BRIDGE PARACORPOREAL LEFT VENTRICULAR ASSIST DEVICE TO ENHANCE PATIENT’S RECOVERY AND IMPROVE CLINICAL OUTCOMES

Pisani Giulia Pinuccia Milanoo (Milanoo) – S.C. Cardiochirurgia E Del Trapianto Di Cuore – Dipartimento Cardiotoracovascolare – ASST Grande Ospedale Metropolitano Milanoo Niguarda | Cannata Aldo Milanoo (Milanoo) – S.C. Cardiochirurgia E Del Trapianto Di Cuore – Dipartimento Cardiotoracovascolare – ASST Grande Ospedale Metropolitano Milanoo Niguarda | Ronco Daniele Milanoo (Milanoo) – S.C. Cardiochirurgia E Del Trapianto Di Cuore – Dipartimento Cardiotoracovascolare – ASST Grande Ospedale Metropolitano Milanoo Niguarda | Velasco Maria Elisabetta Milanoo (Milanoo) – S.C. Cardiochirurgia E Del Trapianto Di Cuore – Dipartimento Cardiotoracovascolare – ASST Grande Ospedale Metropolitano Milanoo Niguarda | De Chiara Benedetta Carla Milanoo (Milanoo) – S.C. Cardiochirurgia E Del Trapianto Di Cuore – Dipartimento Cardiotoracovascolare – ASST Grande Ospedale Metropolitano Milanoo Niguarda | Russo Claudio Francesco Milanoo (Milanoo) – S.C. Cardiochirurgia E Del Trapianto Di Cuore – Dipartimento Cardiotoracovascolare – ASST Grande Ospedale Metropolitano Milanoo Niguarda

Short term mechanical circulatory support (ST-MCS) could be a bridge-to-bridge strategy in INTERMACS-1 patients candidate to intracorporeal left ventricular assist device (LVAD). In this setting cannulation is usually performed through femoro-femoral percutaneous access. Nevertheless, it hinders nursing and patient’s early mobilization. Here we describe our strategy for the reconfiguration of the ST-MCS to ease patient’s recovery before intracorporeal LVAD implantation. A 45 years old man was transferred to our Center in refractory cardiogenic shock, supported by means of femoro-femoral V-A ECMO and intra-aortic balloon pump. Four days earlier an acute myocardial infarction occurred on the left venticle anterior wall, complicated by an impending myocardial rupture. On ECMO primary PCI was performed on the culprit lesion and then a pericardial patch was applied over the infarcted area through a median sternotomy. After a week, severe mechanical hemolysis occurred, secondary to thrombosis of the venous femoral cannula and the left atrial vent. Therefore, we reconfigured ST-MCS to paracorporeal LVAD: inflow cannula was inserted into the left ventricular apex and connected to a CentriMag System™ and the ECMO cannula in the femoral artery was used as outflow. On full LVAD support, right ventricular failure occurred. A paracorporeal Right–Oxygenator-VAD (Oxy-RVAD) was implanted. ECMO cannula in the femoral vein was replaced and adopted as inflow, whereas the outflow cannula was anastomosed to the main pulmonary artery. Oxy-RVAD was removed successfully after 9 days. To ease patient’s mobilization, on day 24 LVAD outflow line was connected to the left axillary artery achieving an apical-axillary LVAD. The day after, we started weaning from sedation and mechanical ventilation. On post-operative day 2 mobilization of upper and lower limbs were started with MOTOmed® training without complications. After 41 days on paracorporeal LVAD support, a HeartMate 3 TM (HM 3 TM ) was finally implanted through left thoracotomy as a bridge to candidacy. Preexisting apical access was used to HM 3 TM inflow cannula implant. Again, RV failure imposed a 10-days period of paracorporeal RVAD support. Overall, in our experience apical-axillary cannulation strategy facilitated patient’s mobilization, enhancing clinical recovery and improving psychological status before intracorporeal LVAD implantation.