Prophylactic LVAD Enabling High-Risk Mitral Repair-Extending Beyond the Guidelines.

• 发表时间: Nov/Dec 2019
• 来源期刊: Innovations (Phila)
• DOI: 10.1177/1556984519874801
• PMID: 31500487
• 文章类型: Case Reports
• 作者列表: Hage F,Hage A,Smith S,Dave Nagpal A,Chu MWA

关键词: LV Recovery; cardiogenic shock; congestive heart failure; high-risk mitral repair; prophylactic left ventricular assist device

Mesh: Aftercare; Cardiac Surgical Procedures / instrumentation; Cardiopulmonary Bypass / standards; Echocardiography; Heart Failure / physiopathology surgery; Heart-Assist Devices / adverse effects standards; Humans; Male; Middle Aged; Mitral Valve Insufficiency / diagnostic imaging surgery; Risk Reduction Behavior; Shock, Cardiogenic / diagnosis etiology; Treatment Outcome; Ventricular Dysfunction, Left / diagnostic imaging surgery; Ventricular Remodeling / physiology

Abstract

Both surgical and percutaneous mitral repair remain contraindicated in patients with severe degenerative mitral regurgitation (DMR) with severe left ventricular (LV) dysfunction because of inadequate LV reserve and increased LV work with a competent mitral valve. We report a 55-year-old gentleman who presented in cardiogenic shock with missed severe DMR and severe LV dysfunction, in whom we performed a high-risk mitral repair and insertion of a prophylactic CentriMag LV assist device. This innovative approach was found to be successful with significant patient improvement in both LV function and clinical symptoms with a competent mitral valve.