Beating heart left ventricle thrombectomy through mini-left-anterior thoracotomy for a patient with cardiogenic shock
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Beating heart left ventricle thrombectomy through mini‑left‑anterior thoracotomy for a patient with cardiogenic shock Masato Mutsuga1 · Akihiko Usui1 Received: 9 July 2020 / Accepted: 3 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Left ventricular (LV) thrombus is frequently occurred with dilated cardiomyopathy (DCM) when a patient receives extracorporeal membrane oxygenation (ECMO) support for cardiogenic shock. LV decompression techniques are sometimes required immediately after ECMO support. However, LV thrombus is a contra indication for LV assist device (LVAD). We planned a mini-left-anterior thoracotomy instead of using sternotomy, and used beating heart under ECMO support. LV was opened through apex and thrombectomy was performed by finger manipulation and the remained thrombus was removed by balloon guided technique. Our technique is a simple and durable method for removing LV thrombus under ECMO support and might be considered as a supplementary procedure before temporally LVAD. Keywords Left ventricle thrombus · Cardiogenic shock · Mini-left-anterior thoracotomy
Introduction In patients with dilated cardiomyopathy (DCM), left ventricular (LV) thrombus is frequently found when a patient receives extracorporeal membrane oxygenation (ECMO) support for cardiogenic shock. The aortic valve does not open sufficiently in this situation; thus, LV thrombus can easily develop. In patients with a high risk of developing systemic embolism, the surgical removal of the thrombus is needed, especially when medical anticoagulant therapy fails [1]. Surgical removal via sternotomy under cardiopulmonary bypass (CPB) with cardiac arrest is the standard technique. Even standard trans-aortic, trans-mitral, or trans-ventricle techniques are considered highly invasive in cardiogenic shock patients [2, 3]. We herein describe our minimallyinvasive technique (MIT) for cardiogenic shock patients, which is performed through anterior mini-thoracotomy, with
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01510-3) contains supplementary material, which is available to authorized users. * Masato Mutsuga [email protected]‑u.ac.jp 1
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai‑cho, Showa‑ku, Nagoya, Aichi 4668550, Japan
a beating heart, under ECMO support before temporary LV assist device (LVAD) implantation as a bridge to candidacy.
Case A 43-year-old man with DCM, have developed a cardiogenic shock and was transferred to our hospital with intra-aortic balloon pumping and ECMO support. His aortic valve did not open sufficiently and a protruding thrombus was detected in the apex of the LV, even if the adequate anti-coagulation was maintained. We applied a MIT for the further implantation of an Impella 5.0 (Abiomed, Danvers, USA).
Surgical technique (Supplemental Video) Beating heart LV thrombectomy is a simple way to remove a thrombus. The patient was placed in the supine position
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