LVAD Implantation in a patient with congenitally corrected transposition of the great arteries

Introduction: Improved medical and surgical treatment strategies led to a tremendous increase of the incidence of end-stage heart failure which has almost tripled during the past years. Due to the fact that, based on organ donor shortage, cardiac transplantation can not solve this widening gap between the need for organs and the annually performed transplantations, the role of alternative treatment strategies for end-stage heart failure are significantly increasing. Consequently LVAD implantations are constantly increasing and becoming more and more a standard in cardiac surgery. Accordingly, the number of atypical cases is rising and there is a need for alternative approaches for unique cases.

In our case, a patient was presented to our department who was suffering from low cardiac output failure in combination with unilateral pulmonary agenesis which is a rare congenital anomaly defined as a complete absence of the lung parenchyma, bronchi, and pulmonary vessels with large clinical variability. The ethological cause is unknown. In a large group of cases cardiovascular, musculoskeletal, gastrointestinal, and renal malformations are common co-morbidities of this disease.

Background: We present a case of a 58-year old female patient with severe end-stage heart failure caused by congenitally corrected transposition of the great arteries (cTGA). Due to repetitive episodes of cardiac decompensation, progressive low cardiac output failure and severe clinical worsening condition, the patient was referred to our hospital for end-stage treatment of his underlying diseases. Right heart catheterization showed a reduced cardiac index conditions (Cardiac index: 1,89 l/min/m² (Fick) ; heart time volume 3,07 l/min) and increased pulmonary hypertension (PAmean 66 mmHg, PCmean 53 mmHg; PVR 347 dyn). After multiple interdisciplinary discussions, left ventricular assist device (LVAD) was implanted. The patient experienced an uneventful intrahospital stay and was successfully discharged to rehabilitation on postoperative day 22.

Discussion: Unique patients require unique approaches. Our Patient still benefits from LVAD therapy. and is a succesful example of LVAD therapy in patients with congenital heart diseases. Still interdisciplinary LVAD evaluation is the key to a patient orientated successful therapy in this special group of cardiomyopathy patients.