Successful resuscitation from restart failure of left ventricular assist device in a patient with aortic valve closure.

Abstract

Once a pump stoppage of left ventricular assist device (LVAD) occurs, the hemodynamic status catastrophically collapses. Usage of an extracorporeal membrane oxygenation system (ECMO) can help organ perfusion, including in the brain; however, blood flow is regurgitated into the left ventricle through the outflow graft of LVAD, resulting in irreversible respiratory failure. This phenomenon might be further aggravated in LVAD patients with aortic valve closure because of no ejection flow through it at all. We experienced a case of successful resuscitation from restart failure of HeartWare LVAD pump during controller exchange in a patient with aortic valve closure. An 18Fr cannula was inserted into the lateral wall of the left ventricle as a vent prior to the outflow graft clamping. The patient was discharged with no neurological disorder. In addition to usual usage of peripheral ECMO system, as well as cardiopulmonary resuscitation, emergency left ventricle venting can contribute to recovery from fatal complication by reducing the abrupt increase of left ventricle pressure.