“Suction Event” in a Patient with a HeartMate II Left Ventricular Assist Device

Case Presentation: A 31 year old male with dilated cardiomyopathy and symptoms of New York Heart Association class IV heart failure presented for left ventricular assist device (LVAD) implantation as destination therapy. The patient was admitted to the hospital approximately one month prior with decompensation of his cardiomyopathy and associated liver failure. The patient was stabilized and was subsequently inotrope dependent requiring a continuous infusion of Dobutamine (5-10 mcg/kg/min) to maintain cardiac output. He was brought to the operating room for a planned left ventricular assist device implantation. After an uneventful operative placement of a HeartMate II (Thoratec Corporation, Pleasanton, CA) LVAD, the device was deaired and cardiopulmonary bypass was weaned. LVAD support was then initiated with the following inotropes: milrinone 0.5 mcg/kg/min, epinephrine 0.05 mcg/kg/min, and vasopressin 0.04 units/min. The LVAD support was slowly increased to 8,000 RPMs. TEE showed a left ventricle that was appropriately decompressed with no significant septal bulging, mild right ventricular hypokinesis, and appropriately placed LVAD inflow and outflow cannulas. At the conclusion of the procedure, LVAD flows ranged from 4.5 to 5.0 liters per minute with the mean arterial pressure in the 60’s. The patient was then transported to the SICU without any significant events.