Left Ventricular Assist Device Implantation in Dextrocardia: Lessons From a Complex Redo Case.

Dextrocardia with situs solitus poses significant surgical challenges for left ventricular assist device (LVAD) implantation, particularly in patients with prior sternotomy and complex valvular disease. We report on a 60 year old man with dextrocardia, advanced heart failure, prior mechanical mitral valve replacement, and bicuspid aortic valve disease who underwent successful Corheart 6 LVAD implantation during redo sternotomy with concomitant bioprosthetic aortic and mitral valve replacement. Intraoperative findings included extensive pannus/thrombus on the mechanical mitral prosthesis (causing relative stenosis) and an unsuspected 10 g left atrial thrombus, both of which were removed. Total cardiopulmonary bypass time was 330 minutes, and aortic cross‑clamp time was 233 minutes. Postoperative acute kidney injury requiring dialysis resolved, and the patient was discharged after 137 days. At 1 year follow-up, the left ventricular end-diastolic diameter decreased from 69 to 66 mm, left ventricular ejection fraction (LVEF) remained stable (28-25%), New York Heart Association (NYHA) class improved from IIIb‑IV to II, and estimated glomerular filtration rate (eGFR) recovered from 32 ml/min at 9 months to 51 ml/min at 1 year.