Heart Mate II Deactivation Using a Left Atrial Appendage Occluder in the Outflow Cannula

Introduction Reverse cardiac remodeling may occur in some LVAD recipients. Although considered the standard therapy, surgical device explantation with repeat sternotomy might be undesirable or very high risk. On the other hand, there are few data reporting minimally invasive percutaneous LVAD deactivation. We describe a case of a man with LVAD malfunction due to driveline fracture and LV function recovery who had a Heart Mate II deactivated with a percutaneous technique using a left atrial appendage occluder (LAAO) positioned inside the outflow cannula. Case Report A 48 yo male patient with previous diagnosis of dilated cardiomyopathy and HMII implanted in 2017 as bridge to transplant was admitted due to device malfunction and alarm triggering after coughing crisis. On admission, the pump was off probably due to driveline fracture, although the patient was asymptomatic and hemodynamically stable. An echocardiogram showed cardiac remodeling and ejection fraction improved from 29% to 69%. The heart team proposed to keep the pump off and to perform a minimally invasive outflow cannula occlusion. A cardiac CT was performed and according to the measured land zone, the LAAO device Lambre (Lifetech Scientific Corp., Shenzhen, China)1824 mm was selected. Through a 5F sheath in the left common femoral artery, a pig-tail catheter was used to obtain an aortography. Through an 8F sheath in the right femoral artery, a 5F pig-tail catheter was placed inside the outflow cannula, then an Amplatz Super-Stiff (Boston Scientific, Marbourough, MA, US) 0.035’’inch wire was advanced to the distal aspect of the graft. Using an over-the-wire technique, a 9F Lambre delivery sheath was positioned, and the Lambre 1824 mm device was released, occluding the outflow cannula from the anastomosis. A new aortography showed decreased flow to the graft. After the procedure, the patient was maintained on anticoagulation and persisted asymptomatic. Echocardiogram one week later showed no flow in the outflow graft. LV ejection fraction remained 60%. He is now in hospital discharge planning. Summary To the best of our knowledge this the first report of LVAD deactivation with the fully recapturable Lambre LAAO device. We propose that the use of a LAA occlude to obstruct HM II outflow cannula is feasible and safe.