Rohm, Charlene L.

The HeartMate 3 Left Ventricular Assist System has demonstrated a reduction in risk of pump thrombosis. The improved hemocompatibility of this device is largely attributed to the pump mechanics including a large-diameter outflow graft, increased retrograde flow through the pump during pump cessation, and the textured blood-contacting surfaces of the pump. We present a 55-year-old man with a HeartMate 3 device who presented with heart failure symptoms, prolonged pump cessation for 7 days, and subtherapeutic anticoagulation therapy. Despite prolonged pump cessation and interrupted anticoagulation therapy, there was no evidence of pump thrombosis as determined by both laboratory and imaging studies. This case suggests favorable hemocompatibility of the HeartMate 3 device, which clinicians may consider in the management of patients needing advanced therapies.

AbstractBackgroundTranscatheter aortic valve‐in‐valve replacement (ViV) has been widely accepted as a less invasive alternative to treat failed aortic surgical or transcatheter bioprosthetic valves. Angulated aortas present an additional challenge, particularly when using self‐expanding transcatheter heart valves (SE‐THV).MethodsTwo patients with failed surgical bioprosthetic aortic valves and one patient with a failed transcatheter bioprosthetic aortic valve underwent transcatheter aortic ViV using SE‐THV. All were deemed high‐risk for surgical aortic valve replacement by a heart team. All three patients had initial failed SE‐THV delivery using a conventional approach with subsequent successful delivery using the endovascular snare technique.ResultsIn Cases 1 and 2, the SE‐THV was biased towards the greater curve of the angulated aorta and behind the outer frame of the bioprosthetic valve frame. An endovascular snare was deployed through a secondary left femoral artery access, and the valve delivery system was advanced through the snare in the ascending aorta. The snare was tightened around the SE‐THV capsule proximal to the hat‐marker, allowing deflection of the SE‐THV and successful delivery. In Case 3, the SE‐THV interacted with the tall frame of a failed SE‐THV. A snare via the left femoral artery was deployed in the descending artery. The SE‐THV was advanced through the snare, and both the snare and SE‐THV were advanced together to the ascending aorta where the SE‐THV was deflected and successfully delivered.ConclusionsThe endovascular snare technique is a feasible option for successful delivery of SE‐THV during transcatheter aortic ViV in failed transcatheter or surgical bioprosthetic valves in angulated aortas.