Surgically Implanted Percutaneous Assist Device After Left Ventricular Assist Device Malfunction as a Bridge to Definitive Therapy.

Patients receiving durable left ventricular assist device (dLVAD) support can experience device malfunction, cardiogenic shock, and/or incomplete unloading. Traditional guidance supports the use of emergent dLVAD exchange or orthotopic heart transplantation (OHT). We challenge this paradigm with evidence from four cases at our institution. This case series highlights the use of a microaxial flow pump (mAFP; Impella 5.5; AbiomedM, Danvers, MA) in the setting of dLVAD malfunction as a bridge to decision. Use of the mAFP in four distinct cases improved end-organ perfusion and increased left ventricular unloading. Therefore, the patients were optimized before the final therapy was chosen. Success was seen in each case, with three undergoing a dLVAD exchange and the other an OHT. This initial evidence supports the role of mAFP as a rescue strategy for patients with malfunctioning dLVAD support. Use of mAFP also allows for potential patient mobilization. This approach may improve patient outcomes in selected cases compared with those that pursue direct and emergent dLVAD exchange.