Left Ventricular Assist Device Implantation in Heart Failure Patients With a Left Ventricular Thrombus C. Engin, T. Yagdi, O. Balcioglu, S. Erkul, B. Baysal, E. Oguz, F. Ayik, P. Ozturk, and M. Ozbaran ABSTRACT Background. In this report, we share our experience with left ventricular assist device (LVAD) implantation in cases with a left ventricular (LV) thrombus. Method. Over the 3 years, more than 100 end-stage heart failure cases have been treated with LVAD implantation in our center, including 6 patients with a LV thrombus. Three were detected using preoperative transthoracic echocardiography. Fifty percent of the patients had dilated cardiomyopathy and the remaining cases had an ischemic etiology. Double inotropic support with dopamine and dobutamine was used in all, with 3 drugs with the addition of adrenaline in 2 patients. In 4 cases we implanted the HeartWare Ventricular Assist System (HeartWare, Inc., Miramar, Fla, United States) and in the remaining 2 patients, the Berlin Heart EXCOR ventricular assist device (Berlin Heart AG, Berlin, Germany) for biventricular support. In 1 patient the apical ventriculotomy was extended to remove an intertrabecular thrombosis and ventricular septal surface covered with a dacron patch to minimize the thrombogenic potential. Results. Two patients died due to sepsis and multiorgan failure. None of the patients experienced a neurological event, pump thrombosis, or pump malfunction. Two subjects underwent re-explorations due to hemorrhage. Two candidates underwent successfull transplantation without any evidence of thrombosis in the explanted heart or device. Conclusion. We believe that patients with a LV thrombus and preserved right ventric- ular function are good candidates for implantation of a LVAD after removing the intracavitary thrombus. W ITH technological advances in ventricular assist devices, new generation pumps now represent viable alterna- tives to heart transplantation with almost equal quality of life at least in the early period. Nevertheless some emergent cases are not ideal candidates for left ventricular assist device (LVAD) implantation. For example, a nonremovable left ventricular (LV) thrombus remains a contrindication. 1 For this scenario, total artificial heart may be more appropriate due to limitations of the organ donor supply. In some reports, a LV thrombus, regardless of its properties, is a relative contraindication because of its thrombogenic potential. In this report, we share our experiences with LVAD implantation in subjects bearing a LV thrombus. METHODS Patients Over the 3 years, we have treated more than 100 end-stage heart failure cases with LVAD implantation, including 6 patients with a LV thrombus. Three of them were detected with a preoperative transthoracic echocardiography, and 1 using by intraoperative transesophageal echocardiography. The thrombus was detected in the remaining 2 cases after apical ventriculotomy. The mean age was 51.8  11.05 years (range 29 – 66) and 83.3% were men. The main reason for mechanical circulatory support was as a bridge to transplantation (n = 5; 83.3%) but 1 (16.7%) was destination therapy. Fifty percent of patients displayed dilated and the others ischemic cardiomyopathy. The preoperative condition of patients was extremely poor. Two were level 1 and 4 were level 2 according to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scale. From the Department of Cardiovascular Surgery, Ege Univer- sity Medical Faculty Hospital, Izmir, Turkey. Address reprint requests to Cagatay Engin, MD, Department of Cardiovascular Surgery, Ege University Medical Faculty Hospital, 35100, Bornova, Izmir, Turkey. E-mail: cagatayengin@ yahoo.com © 2013 by Elsevier Inc. All rights reserved. 0041-1345/–see front matter 360 Park Avenue South, New York, NY 10010-1710 http://dx.doi.org/10.1016/j.transproceed.2013.02.071 Transplantation Proceedings, 45, 1017–1019 (2013) 1017