EFFICACY AND LIMITATION OF A LEFT-VENTRICULAR ASSIST SYSTEM IN A PATIENT WITH DILATED CARDIOMYOPATHY ACCOMPANYING MULTIORGAN DYSFUNCTION

A left ventricular assist system (LVAS, Toyobo CO., LTD., Japan) was u sed to provide Life support for 190 days in a 44-year-old male patient with end-stage dilated cardiomyopathy. Before LVAS implantation, hear t failure and cardiogenic shock with multi-organ dysfunction progresse d despite the use of intra-aortic balloon pumping (18 days), mechanica l ventilatory support (15 days), continuous veno-venous hemofiltration (two days) and intravenous administration of catecholamines. Before L VAS implantation, the patient had marked hepatic and renal dysfunction (total bilirubin 6.1, BUN 73 and serum creatinine 3.1 mg/dl), Those f unctions returned to normal (total bilirubin 1.2, BUN 11 and serum cre atinine 0.6 mg/dl) one month after implantation. He was complicated by multiple cerebral embolisms occurring on the 9th, 57th and 175th post operative days and died 190 days after surgery. Autopsy showed thrombi attaching to the diaphragm of the blood pump and multiple embolisms i n the kidney and the spleen. By scanning electron microscopic examinat ion, initial thrombi with attached erythrocytes were seen on the diaph ragm surface without intimal Lining formation. In conclusion, LVAS sup port can be useful for patients with endstage heart disease complicate d by multi-organ dysfunction. However, the LVAS may cause thromboembol ic complications over the prolonged use.