Left Ventricular Assist Device Implantation Combined with Surgical Ventricular Reconstruction

Nine months after sustaining a transmural anteroseptal myocardial infarction, a 45-year-old man presented with ischemic heart disease, severe mitral valve insufficiency, New York Heart Association functional class IV congestive heart failure, and a left ventricular aneurysm. Coronary angiography revealed 3-vessel disease. Echocardiography showed severe left ventricular impairment, pronounced thrombosis in the left ventricular apex, and low myocardial reserve. To reduce the high risk of performing left ventricular and mitral valve reconstruction concurrently with revascularization, we decided to perform ventricular reconstruction and to implant a Berlin Heart INCOR left ventricular assist device as a bridge to heart transplantation. The patient had an uncomplicated recovery, was discharged from the hospital with symptomatic improvement after 20 days, and was placed on the list for heart transplantation. We describe the patient''s case, the surgical procedure, and the reasoning behind the chosen course of treatment.Key words: Cardiac surgical procedures/methods, cardiac volume/physiology, heart aneurysm/surgery, heart failure/complications, heart-assist devices, prosthesis implantation/methods, reconstructive surgical procedures, treatment outcome, ventricular dysfunction, left/surgeryLeft ventricular (LV) reconstructive surgery is one method of treatment for patients who have ischemic heart disease with LV aneurysm and concomitant congestive heart failure.^1–3 However, preoperative deterioration of hemodynamic status is associated with high risk in such patients, who are candidates for heart transplantation. We present the case of a man who underwent LV reconstructive surgery combined with LV bypass with use of the Berlin Heart INCOR® LV assist device (LVAD) (Berlin Heart GmbH; Berlin, Germany).