Redo Heart transplantation in a high-risk patient due to severe aortic regurgitation and accompanying right ventricular failure after LVAD implantation and temporary RVAD support

Abstract Background: We report a 62-year-old patient who received redo-orthotopic Heart transplantation due to worsening severe aortic regurgitation after 19 months of continuous flow LVAD (cf-LVAD) and temporary RVAD support for one month. Case Report: The patient received a heartware LVAD (HVAD) and annuloplasty of the tricuspid valve due to end-stage heart failure (as a consequence of dilated cardiomyopathy) and severe tricuspid regurgitation in addition to right-sided ECMO implantation. Postoperatively due to the inability to wean the implanted ECMO, a temporary RVAD was implanted after which the patient’s condition improved so that it had been explanted later and the patient was discharged after nine-month. In immediate post-operative echo, minimal aortic regurgitation was noted but in the follow-up transthoracic echocardiograms, there was a gradual increase in the severity of aortic regurgitation with worsening both right and left ventricular functions. TAVI was not an option due to unfavourable anatomical issues. That’s why the patient was listed for urgent heart transplantation, performed 19 months after the LVAD implantation. The postoperative course was complicated due to acute renal failure. After recompensation, dialysis, and intensive physiotherapy, the patient could be discharged home after three months. Conclusion: severe aortic regurgitation is a recognizable complication after cf-LVAD implantation which in our case was managed successfully with orthotopic heart transplantation in this high-risk patient.