Abstract
Background: We report a 62-year-old patient who received
redo-orthotopic Heart transplantation due to worsening severe aortic
regurgitation after 19 months of continuous flow LVAD (cf-LVAD) and
temporary RVAD support for one month.
Case Report: The patient received a heartware LVAD (HVAD) and
annuloplasty of the tricuspid valve due to end-stage heart failure (as a
consequence of dilated cardiomyopathy) and severe tricuspid
regurgitation in addition to right-sided ECMO implantation.
Postoperatively due to the inability to wean the implanted ECMO, a
temporary RVAD was implanted after which the patient’s condition
improved so that it had been explanted later and the patient was
discharged after nine-month. In immediate post-operative echo, minimal
aortic regurgitation was noted but in the follow-up transthoracic
echocardiograms, there was a gradual increase in the severity of aortic
regurgitation with worsening both right and left ventricular functions.
TAVI was not an option due to unfavourable anatomical issues. That’s why
the patient was listed for urgent heart transplantation, performed 19
months after the LVAD implantation. The postoperative course was
complicated due to acute renal failure. After recompensation, dialysis,
and intensive physiotherapy, the patient could be discharged home after
three months.
Conclusion: severe aortic regurgitation is a recognizable
complication after cf-LVAD implantation which in our case was managed
successfully with orthotopic heart transplantation in this high-risk
patient.
Keywords: aortic regurgitation, LVAD, heart transplantation,
right ventricle failure