Early LVAD Implantation in a Patient with Left Ventricular Failure after Aortic Dissection with Left Main Stem Involvement

BACKGROUND: 

Coronary involvement in aortic dissection heralds a poor outcome. Involvement of the left main stem may lead to left ventricular (LV) failure requiring mechanical circulatory support.

CASE REPORT: 

A staged approach was applied in a 24-year-old female who suffered extensive infarction due to aortic dissection with left main stem involvement. After replacement of the ascending aorta and grafting of the left internal thoracic artery to the left anterior descending artery following a failed attempt at reconstruction of the left coronary ostium, she failed to wean from cardiopulmonary bypass (CPB) and underwent implantation of an extracorporeal life support (ECLS) system as a bridge to decision. Subsequent implantation of a left ventricular assist device (LVAD) as a bridge to recovery/transplantation was followed by an uneventful further course.

CONCLUSIONS: 

Our experience suggests that early implantation of a ventricular assist device (VAD) as bridge to recovery/transplantation is an alternative to prolonged ECLS in patients who suffered extensive myocardial infarction in the course of aortic dissection.