Beating the Odds: Successful Same-Day Thrombectomy and Heart Transplant in a Pediatric VAD Patient

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Heart Lung Transplant

Abstract

Introduction: Thromboembolic strokes (TS) impose a significant challenge in managing pediatric patients on ventricular assist devices, often leading to neurological impairment and jeopardizing heart transplant (HT) candidacy. We present the case of a young male with dilated cardiomyopathy (DCM) supported by an Impella device who underwent successful same-day mechanical thrombectomy and HT. Case Report: A 47 Kg, 13-year-old male with DCM and Klinefelter syndrome presented with worsening heart failure symptoms and severely depressed left ventricular (LV) function. After failing to wean off inotropes, an Impella 5.5 left ventricular assist device (LVAD) was implanted. He developed de novo HLA antibodies (cPRA of 78%), significantly limiting the donor pool. After 27 days post-LVAD, a donor became available that had no HLA incompatibility. While undergoing donor evaluation, the patient developed acute right facial droop, right-sided weakness, and aphasia, with low-flow Impella alarms. CT angiography confirmed complete occlusion of the left middle cerebral artery (MCA). Stroke team was activated and he underwent mechanical thrombectomy resulting in complete restoration of MCA flow and immediate resolution of neurological symptoms. A multidisciplinary team assessed the risks and benefits of proceeding with HT given the risk of intracranial hemorrhage related to hemorrhagic transformation of the stroke following mechanical thrombectomy versus deactivation from the transplant list. Given the high PRA and potential delay in finding another suitable donor, a decision was made to proceed with HT. The patient underwent successful HT the same day. At 8 months post HT, he has achieved near complete recovery of neurological deficits. Summary: TS in pediatric VAD patients can lead to delays in HT candidacy or ineligibility due to the risk of hemorrhagic conversion and irreversible damage. Timely multidisciplinary decision making for intervention enabled successful neurological recovery and successful HT. [Formula presented]

Volume

44

Issue

4

First Page

S334

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