Long-Term Mechanical Circulatory Support in Patients with Heart Failure with Preserved Ejection Fraction

Objectives: Only few patients with heart failure with preserved ejection fraction (HFpEF) undergo durable mechanical circulatory support (d-MCS) implantation. We describe two different surgical approaches for d-MCS implantation in patients with HFpEF in whom implantation of a total artificial heart was not suitable.

Methods: In 2019, we identified two patients with HFpEF who were listed for high-priority heart transplantation and due to further deterioration needed d-MCS as bridge to transplant therapy.

Result: In a 49-year-old female with hypertrophic cardiomyopathy and left ventricular end-diastolic volume (LVEDV) of 40 mL, resection of the hypertrophic papillary muscles and myocardium, as well as all visible parts of the mitral valve was performed to allow for subsequent intracorporeal left ventricular assist device (LVAD) implantation was performed.

In a 31-year-old woman with restrictive cardiomyopathy and LVEDV of 33 mL, paracorporeal biventricular assist device implantation was performed. Left atrial cannula was placed in the posterior left atrial wall between the left and right inferior pulmonary veins.

Conclusion: In patients with small LV cavities due to hypertrophic cardiomyopathy, myectomy as well as resection of the mitral valve via the apex may be performed to maximize LV dimensions to allow for intracorporeal LVAD implantation. For patients with minimal residual LV cavities (LVEDV < 40 mL) paracorporeal biventricular assist device with left atrial cannulation may present the best treatment option.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021