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.