Extended support of HeartMate 3 with transseptal left atrial cannulation using a modified wire-reinforced graft: a case report.

Abstract

Background: A small left ventricular cavity is one of the major limitations of HeartMate 3 implantation. Therefore, innovations in implantation techniques are required to expand the use of HeartMate 3, the only durable ventricular assist device approved by the US Food and Drug Administration for use in adults.

Case summary: A 65-year-old male was diagnosed with multiple myeloma (MM) and cardiac amyloidosis. Guideline-directed medical therapy was used to treat heart failure secondary to restrictive cardiomyopathy with a small left ventricle (LV). However, after three chemotherapy courses for MM, the patient developed refractory acute decompensated heart failure. He underwent urgent HeartMate 3 implantation as a bridge to chemotherapy. We adopted the left atrium-to-aorta configuration for HeartMate 3 implantation and performed trans-septal left atrial cannulation using a modified Intergard Woven vascular graft. After discharge, the patient resumed chemotherapy on post-operative day 172 and achieved complete response on post-operative day 259. At the time of writing this report, he has been supported with HeartMate 3 for 36 months, and no major adverse events have been recorded.

Discussion: In most reports of trans-septal left atrial cannulation for durable ventricular assist device implantation, a 20-mm ringed Gore-Tex graft was used as the interposition conduit. Some technical difficulties with this graft have been described. Thus, we decided to modify the Intergard Woven graft as the interposition conduit. The favourable outcome in our patient could suggest the potential of extended support with the left atrium-to-aorta configuration of HeartMate 3 for patients with a small LV.