2005 OPEN FORUM Abstracts
VENTRICULAR ASSIST DEVICE AS A LIFESAVING PROCEDURE: CASE REPORT
John Bishop, RRT, Linda Dominy, RRT, MHA, Catherine Oteo, RN, B.S.N., An Van Nguyen, RRT, Jeremy London, MD. Memorial Health University Medical Center, Savannah, Georgia.
Introduction: The Ventricular assist device (VAD) can be used as a bridge to rest the heart allow recovery and be discontinued when the heart functioning at a higher capacity. In this case we present a difficult to wean post-CABG when the VAD was applied to recuperate the heart.
Case presentation: A 54 year old male, 1.7 m, 98.8 kg with history of hypertension, hyperlipidemia, and decreased left ventricular function presented to his cardiologist complaining of external jaw pain with exertion and intermittent chest pain. Echo revealed reduction in LV function and segmental wall abnormalities. Coronary catheterizing showed severe vessel disease with total occlusion of the left anterior descending, severe ostial to proximal disease of the large circumflex system, and severe disease of the right coronary artery. It was recommended that surgical revascularization was needed and was referred for surgery. Surgical revascularization was performing and four vessels were grafted. During surgery he developed severe dysrhythmias in spite of inotropic and IABP support. Attempt at weaning from bypass resulted in ventricular tachycardia / fibrillation. The patient was placed on LVAD (Abiomed BVS 5000 - applying LV support only). After 48 hours VAD was weaned.Intraoperative Tranesophageal echocardiography showed EF of 20-25%, pre-op baseline. ICD was implanted prior to discharge for dysrhymias. Discussion: This patient's severe disease leaded to prompt intervention. Peri-operative MI, stunt myocardium, and hibernating myocardium required continue support for recuperation. VAD was applied post-op during myocardial recovery. This patient's heart was given time to rest and recover. He was successfully discharged.