Plasma exchange for hyperbilirubinemia following implantation of a left ventricle assist system - A case report

A 49-year-old patient with end-stage dilated cardiomyopathy underwent impla ntation of a left ventricular assist system (LVAS), Although the systemic c irculation seemed to be improved, the serum total bilirubin (Tbili) level i ncreased sharply in the early postoperative period (preoperative Tbili, 5.7 mg/dl; postoperative day 3, 33.6 mg/dl). Plasma exchange (PE) was performed 7 times from postoperative day 4, and the Tbili level decreased to 16.3 mg /dl by postoperative day 11. Thereafter, serum Tbili normalized concomitant with improved circulatory condition, The cause of the hyperbilirubinemia w as considered to be temporary right ventricular dysfunction or hepatic sinu soid endothelial dysfunction. The liver function was recoverable, so PE had been effective in this case. Unfortunately, the patient suffered a midbrai n infarction and ultimately died. From this experience, PE is recommended i f it is judged that liver function can be preserved and circulation is adeq uate, but its implementation should not be delayed. It: is essential that L VAS is implanted before damage occurs to end-organ function and thus preven t hyperbilirubinemia.