Abstract 18267: Successful C-Section Delivery at 36 Weeks in a Patient With a Heartmate 3 LVAD

• DOI: 10.1161/circ.148.suppl_1.18267
• Publication Date: 2023-12-19T08:12:47Z
• Authors: Cullen Soares; Michael Plazak; Karl Seif; Ryan Brophy; Lynn Dees; Amanda Nevin; Kristin Murphy; SHOBANA BHARADWAJ; Katelyn T Scharf; Aaron Sachs; Lisa Forbess; Stanley Liu; Siamak Dahi; Warren Naselsky; Alison Grazioli; Susan Sankova; Allison Lankford; Manjula Ananthram
• Keywords: Transthoracic echocardiogram

Introduction: Pregnancy in patients with advanced heart failure requiring left ventricular assist device (LVAD) support is risky and discouraged, though there are cases of successful deliveries. Hypothesis: A 29-year-old G3P2002 female history embolic cerebrovascular accident, postpartum hemorrhage, peripartum cardiomyopathy status-post HeartMate 3 (HM3) LVAD, became pregnant after intrauterine dislodgement. She elected to continue the pregnancy against advice maternal-fetal medicine (MFM). multidisciplinary team convened plan for delivery. Methods: Warfarin sacubitril-valsartan were stopped due teratogenicity. Therapeutic anticoagulation enoxaparin injections was started. Aspirin continued. Low-dose digoxin added right support. involving anesthesiology, MFM, (AHF) convened. Through patient-centered shared decision-making, cesarean delivery planned 36 weeks. seen by MFM AHF every two weeks LVAD speed optimization under transthoracic echocardiogram (TTE) guidance anti-Xa monitoring. Results: The patient electively admitted at 35 pre-delivery optimization. Enoxaparin switched an unfractionated heparin infusion. Betamethasone administered facilitate fetal lung maturation. Twice-daily non-stimulation tests performed. optimized TTE guidance. Continuous hemodynamic monitoring performed perioperatively a Swan-Ganz catheter arterial line. Femoral veno-arterial sheaths placed case extracorporeal membrane oxygenation needed. Anesthesia via spinal-epidural approach. modulated as healthy neonate delivered section without complication days. Conclusions: during remains extremely high-risk clinical situation, this demonstrates that it possible carry such near-term.