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<p>Heart failure (HF) is a leading cause of morbidity and mortality. Mechanical circulatory support (MCS), such as the HeartMate 3 left ventricular assist device (LVAD), is a therapeutic option for patients who are ineligible for heart transplantation. Right heart failure (RHF), depending on the clinical criteria applied for its diagnosis, occurs in 10–40% of patients following LVAD implantation and significantly worsens prognosis. This report presents a 69-year-old male with chronic ischemic HF, prior cardiac resynchronization therapy with defibrillator (CRT-D) implantation, and coronary intervention with drug-eluting stents. Due to progressive mitral regurgitation (MR) and elevated HF biomarkers, MitraClip implantation was performed with initial clinical improvement. Subsequently, left ventricular function deteriorated despite optimized pharmacotherapy, leading to HeartMate 3 LVAD implantation. The postoperative course was complicated by recurrent cardiac tamponade requiring surgical management. Progressive RHF necessitated temporary support with an Impella RP device. Further complications included recurrent infections, sepsis, respiratory failure, and acute kidney injury requiring renal replacement therapy. Despite comprehensive treatment, progressive multiorgan failure and severe cachexia developed. Given the patient’s status as a destination therapy, care was transitioned to home-based palliative management. This case illustrates the complexity of managing end-stage HF with LVAD support, highlighting the frequent complications such as RHF and infections, and the importance of recognizing when to prioritize comfort in advanced disease.</p>

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Use of LVAD HeartMate 3 and Impella RP in the management of advanced heart failure in an elderly patient: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月18日

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  • Maja Butrym,
  • Kacper Jaros,
  • Andrzej Juraszek,
  • Tomasz Hrapkowicz

摘要

Heart failure (HF) is a leading cause of morbidity and mortality. Mechanical circulatory support (MCS), such as the HeartMate 3 left ventricular assist device (LVAD), is a therapeutic option for patients who are ineligible for heart transplantation. Right heart failure (RHF), depending on the clinical criteria applied for its diagnosis, occurs in 10–40% of patients following LVAD implantation and significantly worsens prognosis. This report presents a 69-year-old male with chronic ischemic HF, prior cardiac resynchronization therapy with defibrillator (CRT-D) implantation, and coronary intervention with drug-eluting stents. Due to progressive mitral regurgitation (MR) and elevated HF biomarkers, MitraClip implantation was performed with initial clinical improvement. Subsequently, left ventricular function deteriorated despite optimized pharmacotherapy, leading to HeartMate 3 LVAD implantation. The postoperative course was complicated by recurrent cardiac tamponade requiring surgical management. Progressive RHF necessitated temporary support with an Impella RP device. Further complications included recurrent infections, sepsis, respiratory failure, and acute kidney injury requiring renal replacement therapy. Despite comprehensive treatment, progressive multiorgan failure and severe cachexia developed. Given the patient’s status as a destination therapy, care was transitioned to home-based palliative management. This case illustrates the complexity of managing end-stage HF with LVAD support, highlighting the frequent complications such as RHF and infections, and the importance of recognizing when to prioritize comfort in advanced disease.