USE OF A PULSATILE RIGHT-VENTRICULAR ASSIST DEVICE AND CONTINUOUS ARTERIOVENOUS HEMODIALYSIS IN A 57-YEAR-OLD MAN WITH A PULSATILE LEFT-VENTRICULAR ASSIST DEVICE

Background: Despite advances in the perioperative treatment of both he art transplant and left ventricular assist device recipients, right-si ded circulatory failure refractory to medical management remains a maj or source of morbidity in the immediate postoperative period. In addit ion, hypervolemia is a frequent complication encountered in the treatm ent of these patients because of their large fluid intake requirements and relative potential for kidney failure. Methods: Previous reports have documented the use of continuous-flow devices to support the fail ing right-sided circulation of patients after both left ventricular as sist device insertion and orthotopic heart transplantation. However, s uch continuous-flow devices may carry the attendant risks of hemolysis and bleeding and may further require 24-hour monitoring by trained pe rsonnel. We report the temporary-use pulsatile Abiomed BVS 5000 right ventricular assist device and continuous arteriovenous hemodialysis in the recipient of a pulsatile TCI HeartMate 1000 IP left ventricular a ssist device both after left ventricular assist device implantation an d after orthotopic heart transplantation. Results: The patient was wel l at 13 months follow-up. Conclusions: The use of right ventricular as sist devices and continuous arteriovenous hemodialysis in both transpl ant and left ventricular assist device recipients undoubtedly will rem ain important as the popularity of these two therapeutic modalities co ntinues to grow.