Left Ventricular Assist Device Implantation and Aneurysmectomy for a Giant Left Ventricular Aneurysm.

BACKGROUND

Implanting a left ventricular assist device (LVAD) for end-stage heart failure with a giant left ventricular aneurysm is challenging, primarily owing to risks of unstable anchoring and inflow malalignment.

CASE SUMMARY: A 68-year-old woman with a giant left ventricular aneurysm underwent bridge-to-transplant LVAD implantation, revascularization, and partial aneurysmectomy. A modified turtleneck technique secured the device. However, profound reverse remodeling caused delayed downward pump migration at 9 months, resulting in cerebral infarction.

DISCUSSION: While the turtleneck technique provides reliable initial anchoring, dynamic postoperative geometric shifts pose ongoing risks. This case underscores the necessity of vigilant serial imaging to detect and manage late pump displacement.

TAKE-HOME MESSAGES: The modified turtleneck technique facilitates stable LVAD implantation in end-stage heart failure patients with giant left ventricular aneurysms. However, profound reverse remodeling postoperatively necessitates serial imaging surveillance to detect and manage delayed pump migration.