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With and without you: LVAD unplugged

Session Poster Session 4

Speaker

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Ventricular Assist Devices
  • Session type : Poster Session

Authors : F Loiacono (Barcelona,ES), S Vazquez (Barcelona,ES), JM Dominguez (Barcelona,ES), G Spitaleri (Barcelona,ES), B Keller (Barcelona,ES), A Castel (Barcelona,ES), M Farrero (Barcelona,ES), F Perez-Villa (Barcelona,ES)

Authors:
F Loiacono1 , S Vazquez1 , JM Dominguez1 , G Spitaleri1 , B Keller1 , A Castel1 , M Farrero1 , F Perez-Villa1 , 1Hospital Clinic de Barcelona, Cardiology - Barcelona - Spain ,

Citation:

We present the case of 64-year-old man previously implanted with left ventricular assist device (LVAD) for end-stage heart failure (HF), who survived three months after deliberately unplugging the device.

The patient suffered from ischemic heart disease due to anterior myocardial infarction, resulting in ejection fraction =18%. He soon developed symptoms of advanced HF, but was diagnosed with colon cancer (pT2 N0 M0) during heart transplant work-up. He underwent surgery and was considered to be free of disease 6 months later. In November 2014 he was  implanted with an LVAD HeartMate 2 device, with uneventful initial course.

Later, despite psycho-social follow-up had deemed favorable previous to the implant, he developed psychopathic behavior including deliberate withdraw of medication (anticoagulants, anti-neurohormonal drugs, etc), which was later re-assumed. Besides, due to poor hygienic conditions, he soon developed exit site infection that led to multiple hospitalizations.

Four years after surgery, and despite medical warning, the patient decided to unplug device batteries, therefore causing the pump to stop. Two weeks later he was hospitalized for HF and treated with iv diurethics. Laboratory did not show a significant increase in LDH. A CT scan showed no evidence of pump thrombosis (considering the limitations of the technique); a transesophageal echo showed laminar flow into apical cannula and no thrombosis (figure 1). Despite that, due to high thrombo-embolic risk and the impossibility to definitely exclude thrombosis inside the pump, the medical team decided not to re-connect the device. According with psychiatric evaluation, we considered contraindicated HTx as well as a new surgery for substitution of the LVAD.

The patient died three months after unplugging his LVAD apparently because of progressive HF. Autopsy did not reveal any thrombosis of the device neither any sign of systemic embolism.

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