Left Ventricular Assist Device Implantation combined with direct transaortic transcatheter valve-in-annular stent implantation after rescue mechanical Bentall procedure, A case report.

Left Ventricular Assist Device Implantation combined with direct transaortic transcatheter valve-in-annular stent implantation after rescue mechanical Bentall procedure, A case report. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Left Ventricular Assist Device Implantation combined with direct transaortic transcatheter valve-in-annular stent implantation after rescue mechanical Bentall procedure, A case report. Yuriy Pya, Makhabbat Bekbossynova, Svetlana Novikova, Serik Alimbayev, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2003586/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ventricular assist devices are an important technological development for patients with decompensated end-stage heart failure as bridging therapy for patients awaiting heart transplantation or as destination therapy. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation. The advantage of our procedure in this case report is a significant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement. Case presentation: A 34-year-old male suffering from Marfan’s syndrome underwent an emergency aortic root replacement with a 27/30 mm St. Jude Medical Masters conducted by the Bentall-De Bono technique combined implantation veno-arterial extracorporeal membrane oxygenation (ECMO): subclavian artery – femoral vein. The patient had been on temporary extracorporeal support for 17 days. There was a progression of renal, respiratory, and heart failure in the postoperative period and echocardiography revealed a left ventricular ejection fraction of about 11%, severe mitral and tricuspid valve regurgitation. Taking into account these indicators LVAD implantation was recommended by the council of doctors. The patient resided in the ICU department for 27 days and was discharged at 45 days after LVAD implantation. Conclusions Currently, an increasing number of patients with previously implanted mechanical prostheses are in need of mechanical circulatory support. At the same time, taking into consideration the high risk of thrombosis, a mechanical prosthesis should be replaced with a biological one. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can significantly aggravate right ventricular failure and increase hospital mortality in such category of patients. left ventricular assist device (LVAD) mechanical aortic valve prosthesis mechanical circulatory support Myval Valve-in-ring Figures Figure 1 Figure 2 Figure 3 Background Ventricular assist devices are an important technological development for patients with decompensated end-stage heart failure as bridging therapy for patients awaiting heart transplantation or as destination therapy. Recently, more patients, with previously having mechanical mitral or aortic valve implantation, have selected left ventricular assist device (LVAD) implantation [ 2 , 3 ]. A preexisting mechanical aortic valve is thought to be a thrombogenic risk factor after LVAD implantation. Usually mechanical aortic valves encountered during LVAD implantation are managed by replacement with a tissue valve or closure of the valve together with a patch [ 1 , 4 , 5 ]. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation. Case Presentation A 34-year-old male suffering from Marfan’s syndrome, had a cardiac surgery before, which was a repair mitral valve on October 17th 2013. On February 7th, 2022 the patient underwent an emergency aortic root replacement with a 27/30 mm St. Jude Medical Masters conducted by the Bentall-De Bono technique combined implantation veno-arterial extracorporeal membrane oxygenation (ECMO): subclavian artery – femoral vein. Preoperative echo showed the following data: aortic diameter 65 mm, left ventricular end-diastolic volume (EDV LV) 221 ml, left ventricular end-systolic volume (ESV LV) 127 ml, left ventricular end-systolic diameter (ESD LV) 5.3 cm, left ventricular end-diastolic diameter (EDD LV) 6.4 cm, ejection fraction (EF) 42%. On February 14, 2022, ECMO was switched to veno-venous (femoral-external jugular). Totally, he had been on temporary extracorporeal support for 17 days. There was a progression of renal, respiratory, and heart failure in the postoperative period. Echocardiography revealed a left ventricular ejection fraction of about 11%, severe mitral and tricuspid valve regurgitation (Table 1 ). Table 1 Time line Echo Date 10/20/2013 02/07/2022 04/04/2022 Ascending aortic, mm 40 65 30 EDV LV, ml 252 221 321 ESV LV, ml 150 127 287 EDD LV, cm 8 6.4 7.5 ESD LV, cm 5.4 5.3 6.9 EF LV, % 40 42 11 EDD RV, cm 2.5 2.3 3.6 TAPSE 2 1.8 0.85 MR - - +++ TR - +/++ +++ Table note: EDV- end diastolic volume, LV- left ventricle, ESV- end sistolic volume, EDD- end diastolic diameter, ESD- end sistolic diameter, EF- ejection fraction, EDD RV- right ventricular end diastolic diameter, TAPSE- tricuspid annular plane systolic excursion, MR- mitral regurgitation, TR- tricuspid regurgitation. In the interdisciplinary case after discussion, we noticed the indication for implantation of LVAD. Preoperative characteristics of the patient are shown in the Table 2 . Table 2 Patient’s demographics preoperative baseline characteristics and laboratory parameters. Demographic data Value Age, years 34 Body mass index, kg/m2 23 Body surface area, m2 2.1 Cardiorespiratory conditions preoperatively INTERMACS class II Intensive Care Unit Length of stay, days 58 Duration of mechanical ventilation, days 58 Hemodialysis prior to surgery, days 21 CVP, mmHg 16 Laboratory parameters White blood cell count, 109/l 13 Creatinine, mg/dl 2.1 Blood urea nitrogen, mg/dl 42 C-reactive protein, mg/dl 10 AST, U/l 16 ALT, U/l 11 Serum bilirubin, mg/dl 1.2 ProBNP 35000 INR 1.8 MELD score 27 Table note: INTERMACS- interagency registry for mechanically assisted circulatory support, AST- Aspartate transaminase, ALT-Alanine aminotransferase, ProBNP - Brain natriuretic peptide test, INR -nternational normalized ratio, MELD score - model for end-stage liver disease. Surgical procedure. Femoral arterial and femoral venous cannulations had been performed before the chest opening. The heart and the ascending aortic graft were mobilized to allow a distal ascending aortic clamp. Antegrade blood cardioplegia was administered. The ascending aortic graft was opened longitudinally. The leaflets of the prosthesis were broken and removed. The crimped ballon expandable transcatheter aortic valve MyVal 27.5 (Meril Life Sciences Pvt. Ltd) was inserted through the ascending aorta, positioned into the mechanical valve (proportion 70/30) and implanted (Fig. 1, 2). The outflow graft of the device (Heart Mate 3 TM Abbott Laboratories, USA) was anastomosed to the ascending aortic graft in an end-to-side type (Fig. 3). Then the cross-clamp was removed. The implantation site of the inflow cannula was chosen anterior to the apex of the left ventricle and 2 cm lateral to the anterior interventricular branch. The orifice of the left ventricle was made with a special apical knife. Then inflow cannula was placed and made tunneling of the driveline. De-airing was done before and after creating the anastomosis between proximal and distal parts of outflow graft. The procedure of implantation driveline is typical for such kind of operation. The LVAD pump was launched, and the cardiopulmonary bypass (CPB) was removed from the patient. After extended bleeding control, the chest was covered. The skin-to-skin time was 380 min. with an acceptable CPB time of 194 min. The aortic cross-clamp time was 43 min. Under low catecholamine as well as inotropic support and nitrogen monoxide (NO), ventilation was provided. The mean arterial pressure, Central venous pressure (CVP), cardiac rhythm and pulmonary capillary wedge pressure were 71mmHg, 9 mmHg, 110 beats\minute, and 12 mmHg, respectively. The pump speed, pump flow and pulse index were 4400 rpm, 3.2 l\min and 4.8 respectively. The patient was transferred to our intensive care unit (ICU). Postoperative echocardiography: AR(0), mean gradient-6mmHg, peak gradient-12mmHg. The patient came to consciousness 2 hours later after surgery and his neurological status was found entirely normal. He was extubated on 21st day. The hemodiafiltration was held during 13 days after surgery. The patient resided in the ICU department for 27 days and was discharged 45 days after LVAD implantation. Discussion With increasing clinical experience in the surgical treatment of heart failure, particularly mechanical circulatory support indications for implantation has been expanded. Currently, an increasing number of patients with previously implanted a mechanical prostheses are in need of mechanical circulatory support. At the same time, taking into consideration the high risk of thrombosis, mechanical prosthesis should be replaced with a biological prosthesis [ 6 , 9 ]. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can significantly aggravate right ventricular failure and increase hospital mortality in such category of patients [ 1 , 7 , 8 ]. The advantage of our procedure in this case report is a significant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement. Conclusions There is lack of information about this surgical procedure in the literature. The valve-in-valve implantation is reasonable way intending reduction of the cardioplegic arrest time and the avoidance of an aggressive aortic root replacement. In order to get reliable and long-term results, a larger and longer follow-up of a larger number of cases should be carried out. List Of Abbreviations extracorporeal membrane oxygenation (ECMO) left ventricular assist device (LVAD) Intensive care unit (ICU) left ventricular end-diastolic volume (EDV LV) left ventricular end-systolic volume (ESV LV) left ventricular end-systolic diameter (ESD LV) left ventricular end-diastolic diameter (EDD LV) ejection fraction (EF) cardiopulmonary bypass (CPB) nitrogen monoxide (NO) Central venous pressure (CVP) Declarations Ethics approval and consent to participate. The case report was approved by the Institutional Review Ethics Committee of the National Re-search Cardiac Surgery Center (#01-97/2022 from 22/04/22), the name of the chairperson of the ethics committee –Alibek Kossumov and has been conducted in accordance with the principles in the Helsinki Declaration. Patient consent. Patient has given his informed consent for participation in the case study and for the publication of photographs. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding The authors report no involvement in the research by the sponsor that could have influenced the outcome of this work. Authors' contributions All authors contributed equally to the manuscript and read and approved the final version of the manuscript. Acknowledgements Authors' information (optional) References Tulimat T, Osman B, Beresian J, Sfeir P, Borgi J. Management of a mechanical aortic valve during left ventricular assist device implantation in a previously replaced aortic root. The International Journal of Artificial Organs 2022;45(2):152–154. doi: 10.1177/0391398821990667 . Lima B, Chamogeorgakis T, Mountis M, Gonzalez-Stawinski GV. Replacement of the aortic valve with a bioprosthesis at the time of continuous flow ventricular assist device implantation for preexisting aortic valve dysfunction. Proc (Bayl Univ Med Cent) 2015;28(4):454–6. doi: 10.1080/08998280.2015.11929306. PMID: 26424939; PMCID: PMC4569222. Dranishnikov N, Stepanenko A, Potapov EV, et al. Simultaneous aortic valve replacement in left ventricular assist device recipients: single-center experience. Int J Artif Organs 2012; 35(7): 489–494. DOI: 10.5301/ ijao.5000102. Gangahanamaiah S and Marasco SF. Rapid deployment of an aortic valve prosthesis during ventricular assist device implantation. J Hear Lung Transplant 2019; 38(4): 478–480. DOI: 10.1016/j.healun.2018.09.023 . Gordon J., O’Malley T., Maynes E., Wood C., Kalantri N., Morris R., et al. Continuous-flow left ventricular assist device implantation in patients with preexisting mechanical mitral valves: a systematic review, Expert Review of Medical Devices 2020; 17:5, 399–404, DOI: 10.1080/17434440.2020.1754190 . John R, Mantz K, Eckman P, Rose A, May-Newman K. Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant 2010;29:1321–9. Wang T., Hernandez A., Felker M., Milano C., Rogers J., Patel C. Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices. Circulation: Heart Failure 2014; 7(1): 215–222. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000473 . Al Saadi T, Andrade A, Chickerillo K, Joshi A, Sciamanna C, Pauwaa S,et al. A case series of patients with left ventricular assist devices and concomitant mechanical heart valves. Artif Organs. 2020;44(10):1050–1054. doi: 10.1111/aor.13702 . Epub 2020 Apr 23. PMID: 32279355. Kiefer P, Hoyer A, Borger MA, Garbade J. Direct transaortic transcather valve-in-valve implantation into a mechanical aortic valve prosthesis during left ventricular assist device implantation: description of a surgical technique. Interact CardioVasc Thorac Surg 2022;34:329–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2003586","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":132660307,"identity":"cc90e49c-ae35-4334-bf6b-3d9d0fac2ea2","order_by":0,"name":"Yuriy Pya","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuriy","middleName":"","lastName":"Pya","suffix":""},{"id":132660308,"identity":"94569a98-e087-46a1-ac84-8151a362f934","order_by":1,"name":"Makhabbat Bekbossynova","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Makhabbat","middleName":"","lastName":"Bekbossynova","suffix":""},{"id":132660309,"identity":"e9d046b1-e131-4194-af50-4905aac9c420","order_by":2,"name":"Svetlana Novikova","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYLCChAMgkhlIGlgQpYGxAaKFLQGoRYJILQxgLTwGQIIILfIzko8/eHDmjpzB7Z6vG34USDCYz0jAr8XgRlpiQ8KNZ8YGd85uu9kDdJjMDUJaeM4YNiR8OJw4c0buths8QC0SEgS0yPec/wjVkvPs5h9itDAc7wGG2I3Dif0SOWy3ibLF4Hib4YyEM4eN+WWOmd2WMZDgkeB5QMBhzcwPPv44dliOTbr52c03f2zkJNgJOQwOoDHCQ6x6BqIicRSMglEwCkYoAAC1yUfZLqwL7gAAAABJRU5ErkJggg==","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Svetlana","middleName":"","lastName":"Novikova","suffix":""},{"id":132660310,"identity":"21badd3e-b9fc-4b86-b726-9a9b9fce20fe","order_by":3,"name":"Serik Alimbayev","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Serik","middleName":"","lastName":"Alimbayev","suffix":""},{"id":132660311,"identity":"a964c2ed-bf73-48b5-9dda-078ffb9658e7","order_by":4,"name":"Abdurashid Mussayev","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdurashid","middleName":"","lastName":"Mussayev","suffix":""},{"id":132660312,"identity":"a801ba4d-403f-4828-b1e2-b43dbcb4d28a","order_by":5,"name":"Maksat Faizulla","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maksat","middleName":"","lastName":"Faizulla","suffix":""},{"id":132660313,"identity":"6584fb09-9099-4813-b537-0e91d60c9635","order_by":6,"name":"Saltanat Andossova","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Saltanat","middleName":"","lastName":"Andossova","suffix":""},{"id":132660314,"identity":"68345dda-c145-4b9a-8ec3-0fbb12d3f9e0","order_by":7,"name":"Timur Lesbekov","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Timur","middleName":"","lastName":"Lesbekov","suffix":""},{"id":132660315,"identity":"5d5b6eab-9aea-4965-99c2-f5123f6f9647","order_by":8,"name":"Aidyn Kuanyshbek","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aidyn","middleName":"","lastName":"Kuanyshbek","suffix":""},{"id":132660316,"identity":"d2ba8aa8-8ca1-420e-9545-07be45a47137","order_by":9,"name":"Ivan Vakhrushev","email":"","orcid":"","institution":"National Research Center for Cardiac Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Vakhrushev","suffix":""}],"badges":[],"createdAt":"2022-08-27 06:14:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2003586/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2003586/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":25944242,"identity":"8987fdff-aaa2-48e9-af90-24f1fc70cf5b","added_by":"auto","created_at":"2022-09-01 17:12:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":806436,"visible":true,"origin":"","legend":"\u003cp\u003e\tThe moment of\u0026nbsp;implanting\u0026nbsp;through the ascending aorta crimped ballon expandable transcatheter aortic valve MyVal 27.5 (Meril Life Sciences Pvt. Ltd).\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2003586/v1/b52a1e11ab3a9b52f049fc81.png"},{"id":25944511,"identity":"7122f19c-0c35-47e0-823c-a6f41eb2b59b","added_by":"auto","created_at":"2022-09-01 17:17:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":901383,"visible":true,"origin":"","legend":"\u003cp\u003e\tSchematic diagram of an operating procedure.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2003586/v1/bb255894e750445f5bfe0f57.png"},{"id":25944241,"identity":"634d8d8c-5c55-4362-a53e-c8a322750a50","added_by":"auto","created_at":"2022-09-01 17:12:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":535408,"visible":true,"origin":"","legend":"\u003cp\u003e\tVisualization of LVAD and prosthesis positioning\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2003586/v1/7934b2f226eee45a8878e9e6.png"},{"id":37066410,"identity":"c4960fa6-1c0a-42d4-b346-eef85427ba65","added_by":"auto","created_at":"2023-05-16 05:44:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3101248,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2003586/v1/7874fb0d-ad37-46aa-a60e-7810188ec48b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Left Ventricular Assist Device Implantation combined with direct transaortic transcatheter valve-in-annular stent implantation after rescue mechanical Bentall procedure, A case report.","fulltext":[{"header":"Background","content":"\u003cp\u003eVentricular assist devices are an important technological development for patients with decompensated end-stage heart failure as bridging therapy for patients awaiting heart transplantation or as destination therapy. Recently, more patients, with previously having mechanical mitral or aortic valve implantation, have selected left ventricular assist device (LVAD) implantation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A preexisting mechanical aortic valve is thought to be a thrombogenic risk factor after LVAD implantation. Usually mechanical aortic valves encountered during LVAD implantation are managed by replacement with a tissue valve or closure of the valve together with a patch [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 34-year-old male suffering from Marfan\u0026rsquo;s syndrome, had a cardiac surgery before, which was a repair mitral valve on October 17th 2013. On February 7th, 2022 the patient underwent an emergency aortic root replacement with a 27/30 mm St. Jude Medical Masters conducted by the Bentall-De Bono technique combined implantation veno-arterial extracorporeal membrane oxygenation (ECMO): subclavian artery \u0026ndash; femoral vein. Preoperative echo showed the following data: aortic diameter 65 mm, left ventricular end-diastolic volume (EDV LV) 221 ml, left ventricular end-systolic volume (ESV LV) 127 ml, left ventricular end-systolic diameter (ESD LV) 5.3 cm, left ventricular end-diastolic diameter (EDD LV) 6.4 cm, ejection fraction (EF) 42%.\u003c/p\u003e \u003cp\u003eOn February 14, 2022, ECMO was switched to veno-venous (femoral-external jugular). Totally, he had been on temporary extracorporeal support for 17 days. There was a progression of renal, respiratory, and heart failure in the postoperative period.\u003c/p\u003e \u003cp\u003eEchocardiography revealed a left ventricular ejection fraction of about 11%, severe mitral and tricuspid valve regurgitation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTime line\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcho Date\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/20/2013\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e02/07/2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e04/04/2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscending aortic, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEDV LV, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESV LV, ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEDD LV, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESD LV, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF LV, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEDD RV, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTAPSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+/++\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eTable note: EDV- end diastolic volume, LV- left ventricle, ESV- end sistolic volume, EDD- end diastolic diameter, ESD- end sistolic diameter, EF- ejection fraction, EDD RV- right ventricular end diastolic diameter, TAPSE- tricuspid annular plane systolic excursion, MR- mitral regurgitation, TR- tricuspid regurgitation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the interdisciplinary case after discussion, we noticed the indication for implantation of LVAD. Preoperative characteristics of the patient are shown in the Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient\u0026rsquo;s demographics preoperative baseline characteristics and laboratory parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index, kg/m2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody surface area, m2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCardiorespiratory conditions preoperatively\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINTERMACS class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensive Care Unit Length of stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of mechanical ventilation, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodialysis prior to surgery, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLaboratory parameters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell count, 109/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine, mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood urea nitrogen, mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein, mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST, U/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT, U/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum bilirubin, mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProBNP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMELD score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eTable note: INTERMACS- interagency registry for mechanically assisted circulatory support, AST- Aspartate transaminase, ALT-Alanine aminotransferase, ProBNP - Brain natriuretic peptide test, INR -nternational normalized ratio, MELD score - model for end-stage liver disease.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSurgical procedure.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFemoral arterial and femoral venous cannulations had been performed before the chest opening. The heart and the ascending aortic graft were mobilized to allow a distal ascending aortic clamp. Antegrade blood cardioplegia was administered. The ascending aortic graft was opened longitudinally. The leaflets of the prosthesis were broken and removed. The crimped ballon expandable transcatheter aortic valve MyVal 27.5 (Meril Life Sciences Pvt. Ltd) was inserted through the ascending aorta, positioned into the mechanical valve (proportion 70/30) and implanted (Fig.\u0026nbsp;1, 2).\u003c/p\u003e\u003cp\u003eThe outflow graft of the device (Heart Mate 3 TM Abbott Laboratories, USA) was anastomosed to the ascending aortic graft in an end-to-side type (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eThen the cross-clamp was removed. The implantation site of the inflow cannula was chosen anterior to the apex of the left ventricle and 2 cm lateral to the anterior interventricular branch. The orifice of the left ventricle was made with a special apical knife. Then inflow cannula was placed and made tunneling of the driveline. De-airing was done before and after creating the anastomosis between proximal and distal parts of outflow graft. The procedure of implantation driveline is typical for such kind of operation. The LVAD pump was launched, and the cardiopulmonary bypass (CPB) was removed from the patient. After extended bleeding control, the chest was covered. The skin-to-skin time was 380 min. with an acceptable CPB time of 194 min. The aortic cross-clamp time was 43 min. Under low catecholamine as well as inotropic support and nitrogen monoxide (NO), ventilation was provided. The mean arterial pressure, Central venous pressure (CVP), cardiac rhythm and pulmonary capillary wedge pressure were 71mmHg, 9 mmHg, 110 beats\\minute, and 12 mmHg, respectively. The pump speed, pump flow and pulse index were 4400 rpm, 3.2 l\\min and 4.8 respectively. The patient was transferred to our intensive care unit (ICU). Postoperative echocardiography: AR(0), mean gradient-6mmHg, peak gradient-12mmHg.\u003c/p\u003e \u003cp\u003eThe patient came to consciousness 2 hours later after surgery and his neurological status was found entirely normal. He was extubated on 21st day. The hemodiafiltration was held during 13 days after surgery. The patient resided in the ICU department for 27 days and was discharged 45 days after LVAD implantation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith increasing clinical experience in the surgical treatment of heart failure, particularly mechanical circulatory support indications for implantation has been expanded. Currently, an increasing number of patients with previously implanted a mechanical prostheses are in need of mechanical circulatory support. At the same time, taking into consideration the high risk of thrombosis, mechanical prosthesis should be replaced with a biological prosthesis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can significantly aggravate right ventricular failure and increase hospital mortality in such category of patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The advantage of our procedure in this case report is a significant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere is lack of information about this surgical procedure in the literature. The valve-in-valve implantation is reasonable way intending reduction of the cardioplegic arrest time and the avoidance of an aggressive aortic root replacement. In order to get reliable and long-term results, a larger and longer follow-up of a larger number of cases should be carried out.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eextracorporeal membrane oxygenation (ECMO)\u003c/p\u003e\n\u003cp\u003eleft ventricular assist device (LVAD)\u003c/p\u003e\n\u003cp\u003eIntensive care unit (ICU)\u003c/p\u003e\n\u003cp\u003eleft ventricular end-diastolic volume (EDV LV)\u003c/p\u003e\n\u003cp\u003eleft ventricular end-systolic volume \u0026nbsp;(ESV LV)\u003c/p\u003e\n\u003cp\u003eleft ventricular end-systolic diameter \u0026nbsp;(ESD LV)\u003c/p\u003e\n\u003cp\u003eleft ventricular end-diastolic diameter (EDD LV)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eejection fraction (EF)\u003c/p\u003e\n\u003cp\u003ecardiopulmonary bypass (CPB)\u003c/p\u003e\n\u003cp\u003enitrogen monoxide (NO)\u003c/p\u003e\n\u003cp\u003eCentral venous pressure (CVP)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case report was approved by the Institutional Review Ethics Committee of the National Re-search Cardiac Surgery Center (#01-97/2022 from 22/04/22), the name of the chairperson of the ethics committee \u0026ndash;Alibek Kossumov and has been conducted in accordance with the principles in the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient has given his informed consent for participation in the case study and for the publication of photographs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no involvement in the research by the sponsor that could have influenced the outcome of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed equally to the manuscript and read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; information (optional)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTulimat T, Osman B, Beresian J, Sfeir P, Borgi J. Management of a mechanical aortic valve during left ventricular assist device implantation in a previously replaced aortic root. The International Journal of Artificial Organs 2022;45(2):152\u0026ndash;154. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0391398821990667\u003c/span\u003e\u003cspan address=\"10.1177/0391398821990667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLima B, Chamogeorgakis T, Mountis M, Gonzalez-Stawinski GV. Replacement of the aortic valve with a bioprosthesis at the time of continuous flow ventricular assist device implantation for preexisting aortic valve dysfunction. Proc (Bayl Univ Med Cent) 2015;28(4):454\u0026ndash;6. doi: 10.1080/08998280.2015.11929306. PMID: 26424939; PMCID: PMC4569222.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDranishnikov N, Stepanenko A, Potapov EV, et al. Simultaneous aortic valve replacement in left ventricular assist device recipients: single-center experience. Int J Artif Organs 2012; 35(7): 489\u0026ndash;494. DOI: 10.5301/ ijao.5000102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGangahanamaiah S and Marasco SF. Rapid deployment of an aortic valve prosthesis during ventricular assist device implantation. J Hear Lung Transplant 2019; 38(4): 478\u0026ndash;480. DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.healun.2018.09.023\u003c/span\u003e\u003cspan address=\"10.1016/j.healun.2018.09.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGordon J., O\u0026rsquo;Malley T., Maynes E., Wood C., Kalantri N., Morris R., et al. Continuous-flow left ventricular assist device implantation in patients with preexisting mechanical mitral valves: a systematic review, Expert Review of Medical Devices 2020; 17:5, 399\u0026ndash;404, DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17434440.2020.1754190\u003c/span\u003e\u003cspan address=\"10.1080/17434440.2020.1754190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohn R, Mantz K, Eckman P, Rose A, May-Newman K. Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant 2010;29:1321\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang T., Hernandez A., Felker M., Milano C., Rogers J., Patel C. Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices. Circulation: Heart Failure 2014; 7(1): 215\u0026ndash;222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/CIRCHEARTFAILURE.113.000473\u003c/span\u003e\u003cspan address=\"10.1161/CIRCHEARTFAILURE.113.000473\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Saadi T, Andrade A, Chickerillo K, Joshi A, Sciamanna C, Pauwaa S,et al. A case series of patients with left ventricular assist devices and concomitant mechanical heart valves. Artif Organs. 2020;44(10):1050\u0026ndash;1054. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/aor.13702\u003c/span\u003e\u003cspan address=\"10.1111/aor.13702\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2020 Apr 23. PMID: 32279355.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiefer P, Hoyer A, Borger MA, Garbade J. Direct transaortic transcather valve-in-valve implantation into a mechanical aortic valve prosthesis during left ventricular assist device implantation: description of a surgical technique. Interact CardioVasc Thorac Surg 2022;34:329\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"left ventricular assist device (LVAD), mechanical aortic valve prosthesis, mechanical circulatory support, Myval, Valve-in-ring","lastPublishedDoi":"10.21203/rs.3.rs-2003586/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2003586/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVentricular assist devices are an important technological development for patients with decompensated end-stage heart failure as bridging therapy for patients awaiting heart transplantation or as destination therapy. This report illustrates a case of a direct transaortic transcatheter valve-in-valve implantation into a mechanical aortic valve prosthesis during LVAD implantation. The advantage of our procedure in this case report is a significant reduction of ischemia time and the avoidance of such an extensive reoperation period as an aortic root replacement.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003eA 34-year-old male suffering from Marfan\u0026rsquo;s syndrome underwent an emergency aortic root replacement with a 27/30 mm St. Jude Medical Masters conducted by the Bentall-De Bono technique combined implantation veno-arterial extracorporeal membrane oxygenation (ECMO): subclavian artery \u0026ndash; femoral vein. The patient had been on temporary extracorporeal support for 17 days. There was a progression of renal, respiratory, and heart failure in the postoperative period and echocardiography revealed a left ventricular ejection fraction of about 11%, severe mitral and tricuspid valve regurgitation. Taking into account these indicators LVAD implantation was recommended by the council of doctors. The patient resided in the ICU department for 27 days and was discharged at 45 days after LVAD implantation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCurrently, an increasing number of patients with previously implanted mechanical prostheses are in need of mechanical circulatory support. At the same time, taking into consideration the high risk of thrombosis, a mechanical prosthesis should be replaced with a biological one. Complete replacement of the aortic root takes a long time, especially under conditions of reoperation period, which can significantly aggravate right ventricular failure and increase hospital mortality in such category of patients.\u003c/p\u003e","manuscriptTitle":"Left Ventricular Assist Device Implantation combined with direct transaortic transcatheter valve-in-annular stent implantation after rescue mechanical Bentall procedure, A case report.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-01 17:12:29","doi":"10.21203/rs.3.rs-2003586/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b430ed86-1883-4940-bb5e-d9f30019dd87","owner":[],"postedDate":"September 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-05-16T05:44:11+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-01 17:12:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2003586","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2003586","identity":"rs-2003586","version":["v1"]},"buildId":"wLkW0s4AflPzk-lpfg-fK","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}