Extracorporeal support for right ventricular failure following LVAD implantation in a 5-year-old child: a case report

Introduction. Postoperative right ventricular failure is a dangerous adverse event in patients after left ventricular assist device (LVAD) implantation. The survival rate of such patients is extremely low. The only strategy that enables patient survival after LVAD implantation is the use of extracorporeal membrane oxygenation (ECMO) to bypass the right ventricle.

The objective was to present a case report on the management of right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation in a 5-year-old child, utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a right ventricular bypass strategy.

Results. Serial echocardiographic assessment under ECMO support revealed progressive RV functional recovery, with FAC increasing from 7% to 28% and TR decreasing from 50% to 15% by postoperative day 10. The patient was successfully weaned from ECMO on day 14 with preserved RV function (FAC 30%, grade 1 TR).

Conclusion. The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a right ventricular bypass strategy provides hemodynamic stabilization, improves oxygenation, and creates optimal conditions for myocardial recovery. This case report demonstrates the efficacy of a gradual ECMO weaning protocol under echocardiographic guidance, which may prove valuable in managing similar clinical scenarios.

1. Poptsov V. N., Spirina E. A., Ryabtsev D. V. et al. The experience of using percutaneous bypass of the right ventricle in the early period after implantation of the left ventricular bypass system (clinical observation and literature review). Bulletin of Transplantology and Artificial Organs, 2023, vol. 25, no. 1, pp. 77–89. (In Russ.). https://doi.org/10.15825/1995-1191-2023-1-77-89.

2. Chernyavsky A. M., Doronin D. V., Fomichev A. V., Karaskov A. M. The first experience of using the AVK-N left ventricular mechanical support system in a cardiac surgery clinic. Pathology of blood circulation and cardiac surgery, 2019, vol. 23, no. 1, pp. 26–32. (In Russ.). http://doi.org/10.21688/1681-3472-2019-1- 26-32.

3. Baxter R. D., Tecson K. M., Still S. et al. Predictors and impact of right heart failure severity following left ventricular assist device implantation. J Thorac Dis, 2019, vol. 11, no. l6, pp. S864–S870. http://doi.org/10.21037/jtd.2018.09.155.

4. Berger R., Hamdoun H., Sandoval Boburg R. et al. Quality of life following urgent lvad implantation for ecmo therapy in cardiogenic shock: a long-term follow-up. Medicina (Kaunas, Lithuania), 2021, vol. 57, no. 8, pp. 747. http://doi. org/10.3390/medicina57080747.

5. Chaudhry S. P., DeVore A. D., Vidula H. et al. Left ventricular assist devices: a primer for the general cardiologist. Journal of the American Heart Association, 2022, vol. 11, no. 24, pp. e027251. http://doi.org/10.1161/JAHA.122.027251.

6. Copeland H., Westfall S., Morton J., Mohammed A. Successful recovery with venovenous ECMO for ARDS after LVAD HeartMate 3 implantation: A case report. J Card Surg, 2022, vol. 37, no. 8, pp. 2450–2452. http://doi. org/10.1111/jocs.16624.

7. Lampert B. C., Teuteberg J. J. Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant, 2015, vol. 34, no. 9, pp. 1123–1130. http://doi.org/10.1016/j.healun.2015.06.015.

8. Lo Coco V., De Piero M. E., Massimi G. et al. Right ventricular failure after left ventricular assist device implantation: a review of the literature. Journal of thoracic disease, 2021, vol. 13, no. 2, pp. 1256–1269. http://doi.org/10.21037/jtd-20-2228.

9. Martens S., Tie H., Kehl H. G. et al. Heart transplantation surgery in children and young adults with congenital heart disease. J Cardiothorac Surg, 2023, vol. 18, pp. 342. http://doi.org/10.1186/s13019-023-02461-5.

10. Martinez J., Amarelli C., Montalto A. et al. CARC5: Optimizing Heart Mate3 LVAD speed using patient-specific hemodynamic analysis. ASAIO Journal, 2022, vol. 68, no. 2, pp. 31. http://doi.org/10.1097/01.mat.0000840884.87631.11.

11. Reid G., Mork C., Gahl B. et al. Outcome of right ventricular assist device implantation following left ventricular assist device implantation: Systematic review and meta-analysis. Perfusion, 2022, vol. 37, no. 8, pp. 773–784. http://doi.org/10.1177/02676591211024817.

12. Rodenas-Alesina E., Brahmbhatt D. H., Rao V. et al. Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review. Frontiers in cardiovascular medicine, 2022, vol. 9, pp. 1040251. http://doi.org/10.3389/fcvm.2022.1040251.

13. Shalabi A., Kachel E., Kassif Y. et al. Unusual complications following left ventricular assisted device implantation: case series. J Cardiothorac Surg, 2021, vol. 16, no. 1, pp. 70. http://doi.org/10.1186/s13019-021-01445-7.

14. Shin Y. R., Park Y. H., Park H. K. Pediatric ventricular assist device. Korean circulation journal, 2019, vol. 49, no. 8, pp. 678–690. https://doi.org/10.4070/kcj.2019.0163.

15. Wasilewski G., Wiśniowska-Śmiałek S., Górkiewicz-Kot I. et al. Outcomes and complications after left ventricular assist device implantation. Transplant Proc, 2024, vol. 56, no. 4, pp. 864–867. http://doi.org/10.1016/j.transproceed.2024.03.021.