Management of Intracranial Hemorrhage During Pulsatile Long-Term Biventricular Support: When Necessity Is the Mother of Invention.

Abstract

Despite improvements in device design and hemocompatibility, intracranial hemorrhage and stroke remain the most feared and devastating complications in patients under mechanical circulatory support. We present the case of a 48-year-old man with advanced heart failure (INTERMACS 3) and severe biventricular dysfunction who underwent biventricular pulsatile paracorporeal device implantation (Berlin Heart Excor®) as a bridge to candidacy. While on the heart transplantation waiting list, the patient experienced an intracranial hemorrhage, which was successfully managed by switching to a less thrombogenic biventricular assist device (Levitronix Centrimag®) using the Excor® cannulae, thus enabling temporary withdrawal of antithrombotic therapy. Heart transplant was performed successfully with no significant complications.