Conservative Management of LVAD-Associated Ventricular Pseudoaneurysm

Abstract

Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery, destination therapy, and heart transplantation. While the use of such devices in patients with advanced heart failure has shown significant survival benefits and improved quality of life, they bear their own risks and complications.¹ Bleeding, infection, pump thrombosis, and stroke are just some of the serious complications associated with LVADs.² LVAD-associated pseudoaneurysms are rare, with prior reports of occurrence at the left ventricular apex and at the anastomosis site of the outflow graft to the ascending aorta.^3,4 Typically, this device-related complication requires surgical repair and, if at all feasible, heart transplantation. However, in cases of difficult anatomy, unfavorable position, and significant comorbidities, surgery may be contraindicated due to high surgical risk. This case portrays a patient suffering from a left ventricular pseudoaneurysm after HeartMate-III implantation that was not amenable to surgical repair due to heightened surgical risk. We document the first pseudoaneurysm associated with the HeartMate-III in available literature and describe a novel management strategy of documented nonoperative course of LVAD-associated pseudoaneurysm, with the patient surviving 56+ months with medical optimization and management.

Keywords: HeartMate-III left ventricular assist device; advanced heart failure; heart assist device; left ventricular assist device; pseudoaneurysm.

Figure 1

Computed tomography scan demonstrated a large left ventricular pseudoaneurysm measuring 10 × 10 × 8 cm in diameter surrounded by a hematoma. Coronal (A, C) and 3-dimensional reconstructed computed tomography (B) are shown. H: head; F: front