Inpatient cardiac rehabilitation after implantation of a total artificial heart (Aeson device CARMAT) in case of ventricular septal defect after infarction.

Abstract

Background: Post-infarction ventricular septal defect (VSD) is a rare but life-threatening complication of myocardial infarction, in severe cases needing heart transplantation. The Aeson Total Artificial Heart (TAH), a bioprosthetic device designed to replace both ventricles, offers an alternative for patients unsuitable for conventional therapies.

Case summary: A 69-year-old male presented in cardiogenic shock following an inferior wall ST-elevation myocardial infarction complicated by a large VSD. Initial support included extracorporeal life system. Surgical repair was unfeasible due to the defect's size and proximity to the atrioventricular valve, leaving insufficient rim for septal reconstruction. Total artificial heart implantation was the only viable option, used as bridge-to-decision therapy given the patient's advanced age. Post-operative recovery was prolonged, but the patient was successfully transferred to an inpatient rehabilitation facility, where structured physiotherapy, endurance, resistance, and mobility training led to significant functional improvement. Close collaboration with a mechanical circulatory support perfusionist resolved recurring TAH alarms related to intraventricular pressure and communication issues adapting the diuretic and antihypertensive medication. The patient was discharged home in stable condition, achieving substantial physical recovery and independence in managing the device.

Discussion: The Aeson TAH proved to be a safe and effective therapy, in particular, as bridge-to-decision therapy in this complex case of post-infarction VSD. Inpatient cardiac rehabilitation played a pivotal role in optimizing physical recovery, managing device-related challenges, and preparing the early transition to an independent living. This case highlights the potential of advanced bioprosthetic solutions and the benefits of a structured rehabilitation system in managing severe cardiac conditions. Further research is needed to evaluate the long-term outcomes and broader applicability of the Aeson TAH.