Approximately 1% of patients undergoing cardiac surgery procedures develop postcardiotomy low-output syndrome (LOS). Impella Recover LP 5.0 (Abiomed, Danvers, MA) is a microaxial left ventricular assist device (LVAD) inserted retrograde into the left ventricle across the aortic valve. Here we report a case of aortic valve replacement with biological prosthesis in a patient with severe aortic regurgitation and impaired left ventricle systolic function, complicated by postcardiotomy LOS and successfully treated with a preoperative-planned use of Impella VAD. A 55-year-old male patient was admitted to our department with the diagnosis of severe aortic regurgitation and impairment of left ventricular function.Taking into account the possibility of recovery of this valvular pathology, it was decided to address the patient to an aortic valve replacement surgery followed by the implantation of an Impella LVAD to sustain the hemodynamic in the immediate perioperative and early postoperative period. In order to perform this operation and despite the patient's young age, we opted for a biological prosthesis. We utilized a 27mm Carpentier–Edwards Perimount Magna Ease bioprosthesis (Edwards Lifesciences, Irvine, CA). The duration of cardiopulmonary bypass was 67 min with 35 min of aortic clamping. As expected, weaning from cardiopulmonary bypass was shortly followed by a postcardiotomy LOS with a progressive decline in medial arterial pressure, an increase of left atrial pressure (24 mmHg) and the necessity of increased inotropic support (15 γ/kg/min of dobutamine and 1 mg/h of norepinephrine). The implantation of the Impella LVAD was performed through the right axillary artery. The clinical conditions of the patient during the next 24 h had gradually stabilized, allowing the progressive reduction of dobutamine (8 γ/kg/min) and norepinephrine (0.5 mg/h). After 48 h we interrupted the infusion of norepinephrine and reduced dobutamine infusion at 5 γ/kg/min. At postoperative day 10, we could remove the Impella LVAD and the ablation has been completed without any complication. During this procedure, the transesophageal echocardiogram showed an LVEF of 35% and an ITV of 13 supported by dobutamine 7 γ/kg/min and proper functioning of the prosthetic valve. In the following 2 weeks we started a progressive weaning of dobutamine till to suspend it at postoperative day 23. The patient was discharged at postoperative day 35.

Elective Impella Recover LP 5.0 utilization for postcardiotomy low-output syndrome after aortic valve replacement

POZZI, Matteo;
2012

Abstract

Approximately 1% of patients undergoing cardiac surgery procedures develop postcardiotomy low-output syndrome (LOS). Impella Recover LP 5.0 (Abiomed, Danvers, MA) is a microaxial left ventricular assist device (LVAD) inserted retrograde into the left ventricle across the aortic valve. Here we report a case of aortic valve replacement with biological prosthesis in a patient with severe aortic regurgitation and impaired left ventricle systolic function, complicated by postcardiotomy LOS and successfully treated with a preoperative-planned use of Impella VAD. A 55-year-old male patient was admitted to our department with the diagnosis of severe aortic regurgitation and impairment of left ventricular function.Taking into account the possibility of recovery of this valvular pathology, it was decided to address the patient to an aortic valve replacement surgery followed by the implantation of an Impella LVAD to sustain the hemodynamic in the immediate perioperative and early postoperative period. In order to perform this operation and despite the patient's young age, we opted for a biological prosthesis. We utilized a 27mm Carpentier–Edwards Perimount Magna Ease bioprosthesis (Edwards Lifesciences, Irvine, CA). The duration of cardiopulmonary bypass was 67 min with 35 min of aortic clamping. As expected, weaning from cardiopulmonary bypass was shortly followed by a postcardiotomy LOS with a progressive decline in medial arterial pressure, an increase of left atrial pressure (24 mmHg) and the necessity of increased inotropic support (15 γ/kg/min of dobutamine and 1 mg/h of norepinephrine). The implantation of the Impella LVAD was performed through the right axillary artery. The clinical conditions of the patient during the next 24 h had gradually stabilized, allowing the progressive reduction of dobutamine (8 γ/kg/min) and norepinephrine (0.5 mg/h). After 48 h we interrupted the infusion of norepinephrine and reduced dobutamine infusion at 5 γ/kg/min. At postoperative day 10, we could remove the Impella LVAD and the ablation has been completed without any complication. During this procedure, the transesophageal echocardiogram showed an LVEF of 35% and an ITV of 13 supported by dobutamine 7 γ/kg/min and proper functioning of the prosthetic valve. In the following 2 weeks we started a progressive weaning of dobutamine till to suspend it at postoperative day 23. The patient was discharged at postoperative day 35.
Heart failure; Cardiac surgery; Aortic valve replacement; Postcardiotomy low-output syndrome; Left ventricle assist device; Bridge to recovery
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11562/659158
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