Conclusion
Durable mechanical circulatory support is becoming increasingly used due
to the shortage of available or suitable donor hearts for end-stage
heart failure. External and intravascular mechanical complications will
arise with increased use of these devices, the use of the bicaval
anastomosis technique for orthotopic heart transplantation, as well as
placement of central venous catheters.
Entrapment of guide wires, catheters or central lines into the right
ventricular inflow valves of a TAH is a fatal complication in the
management of this patient population11. Although
stent placement for SVCS caused by external compression due to bleeding
and tamponade in TAH has previously been described10,
the risk of stent migration in endovascular stenting in those with
SVCS9 could create lethal outcomes in this population.
In life-threatening situations such as profound hypoxic lung dysfunction
and adult respiratory distress syndrome after TAH
implantation12,13 invasive instrumentation with the
help of guide wires has been performed successfully. Here we describe a
safe and feasible treatment option in TAH patients with hemodynamically
relevant SVCS caused by primarily vascular related impairment with
venoplasty of the SVC.
The development of SVCS after advanced cardiac therapy therapies,
including TAH and heart transplantation may have multiple contributing
factors. In patients with TAH after heart transplantation, the
development of a SVC stenosis may have a higher incidence due to
remaining donor heart tissue that may be a focus of immune related
changes with the development of scarring and/or necrosis, especially if
immunosuppressive therapy is stopped after the graft has been removed
and TAH implanted. Patients with the need of TAH after orthotopic heart
transplantation, multiple manipulations due to central line placement in
the SVC, defibrillator or pacemaker insertion and manipulations, heart
transplant recipients with bicaval rather than biatrial anastomosis
between the recipient and the donor heart, all may have a higher
tendency to develop SVCS although this remains a topic of clinical
observation and discussion.