Implantation of Left Ventricular Assist Device After Descending Aortic Stent Graft for Mural Thrombus

  • Aakash Shah Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  • Bella Onwumbiko Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  • Carlos O. Encarnacion Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  • Eric Krause Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  • Erik Sorensen Department of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
  • Shahab Toursavadkohi Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  • Bartley P. Griffith Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  • Zachary N. Kon Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
  • David Kaczorowski Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
Keywords: mural thrombus, thoracic endovascular aortic repair, ventricular assist device

Abstract

In patients with intraluminal thrombus, commonly applied temporary circulatory support modalities are contraindicated secondary to concern regarding distal or proximal (specifically veno-arterial extracorporeal membrane oxygenation) embolization of the thrombus. Therefore, in patients with cardiogenic shock and synchronous intraluminal descending aortic thrombus, support options are quite limited. We report a case of a 66-year-old man in cardiogenic shock, due to an ischemic cardiomyopathy, who also had intramural thrombus with an intraluminal component in the descending thoracic aorta. An endovascular stent graft was inserted inside the aorta over the location of the mural thrombus. This allowed for the placement of an intra-aortic balloon pump (IABP) for pre-operative optimization. After 3 days, a left ventricular assist device (LVAD) was implanted via left anterolateral thoracotomy with hemi-sternotomy, and the IABP was removed. Post-operatively, he had a relatively uncomplicated course without signs of embolic phenomena and ultimately was discharged home. Surveillance computed tomography imaging at 6 months showed no endovascular leak or migration of the stent. This case demonstrates the feasibility of aortic stent graft placement to allow safe insertion of an IABP in the setting of aortic mural thrombus.  Furthermore, it demonstrates the safety and feasibility of LVAD implantation after recent aortic stent graft placement.

References

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Published
2020-01-28
How to Cite
Shah, A., Onwumbiko, B., Encarnacion, C., Krause, E., Sorensen, E., Toursavadkohi, S., Griffith, B., Kon, Z., & Kaczorowski, D. (2020). Implantation of Left Ventricular Assist Device After Descending Aortic Stent Graft for Mural Thrombus. The Heart Surgery Forum, 23(1), E007-E009. https://doi.org/10.1532/hsf.2675
Section
Articles