Case report
A 58-year-old man with ischemic cardiomyopathy in SVIT underwent LVAD (HeartMate II; Thoratec Corporation, Pleasanton, CA) implant on November 2009. The postoperative course was uncomplicated and he was discharged home in healthy condition.
In the following years he remained in stable clinical conditions (NYHA class I-II) with a good quality of life (KCCQ=79). LVAD parameters were always stable. He was regularly followed-up at our Centre (Figure 1). Up to ten years after surgery, chest X-ray never reported signs of pulmonary congestion (Figure 2).
No events of LVAD thrombosis or device dysfunction occurred ever. During time he developed a progressive chronic renal failure with preserved urinary output, now in stage IIIb KDOQI (eGFR 40 ml/min). During the last year, the patient needed a new hospitalization for recurrent severe gastrointestinal bleeding, requiring multiple endoscopic treatments, prolonged discontinuation of antiplatelet and anticoagulant regimens (15-days during which the INR was always ≤1.4), and transitory administration of octeotride and fresh frozen plasma. Despite that, no thrombotic event occurred, and no LVAD dysfunction developed. Subsequent postoperative course complicated further with pneumonia, successfully treated with antibiotic therapy and non-invasive positive-pressure ventilation. The patient successfully recovered and is next to be discharged in rehabilitation after 4 months of hospitalization.
Last echocardiography (after 123 months from LVAD implant) showed normal inflow and outflow doppler-signals, mild aortic valve regurgitation, and a moderate right ventricular dysfunction with mild tricuspid regurgitation. Despite that, the patient was hemodynamically stable in NYHA class II, with stable LVAD parameters.
Because of the overall successful postoperative course and the good hemodynamic stability, HT was not offered during years.