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<article article-type="abstract" dtd-version="1.0" xml:lang="en" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">CC</journal-id>
<journal-id journal-id-type="nlm-ta">Cardiol Croat</journal-id>
<journal-title-group>
<journal-title>Cardiologia Croatica</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Cardiol. Croat.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">1848-543X</issn>
<issn pub-type="epub">1848-5448</issn>
<publisher><publisher-name>Croatian Cardiac Society</publisher-name></publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">CC_11(10-11)_407</article-id>
<article-id pub-id-type="doi">10.15836/ccar2016.407</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Extended Abstract</subject></subj-group>
</article-categories>
<title-group>
<article-title>Left ventricular assist device impantation as bridge to recovery: case report</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-4488-0559</contrib-id><name><surname>&#x0160;iki&#x0107;</surname><given-names>Jozica</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-6926-9436</contrib-id><name><surname>Sutli&#x0107;</surname><given-names>&#x017D;eljko</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-3090-2772</contrib-id><name><surname>Star&#x010D;evi&#x0107;</surname><given-names>Boris</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-4351-1102</contrib-id><name><surname>Stip&#x010D;evi&#x0107;</surname><given-names>Mira</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-9833-832X</contrib-id><name><surname>Planinc</surname><given-names>Mislav</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-7349-6137</contrib-id><name><surname>Jurinjak</surname><given-names>Sandra Jak&#x0161;i&#x0107;</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-9912-2179</contrib-id><name><surname>Udovi&#x010D;i&#x0107;</surname><given-names>Mario</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-0773-4720</contrib-id><name><surname>Si&#x010D;aja</surname><given-names>Mario</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-7125-361X</contrib-id><name><surname>Bla&#x017E;ekovi&#x0107;</surname><given-names>Robert</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-8502-7816</contrib-id><name><surname>Gulin</surname><given-names>Dario</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib>
<aff id="aff1"><label>1</label>University Hospital &#x201C;Sveti Duh&#x201D;, Zagreb, <country>Croatia</country></aff>
<aff id="aff2"><label>2</label>University Hospital Dubrava, Zagreb, <country>Croatia</country></aff>
</contrib-group>
<author-notes>
<corresp id="cor1">Address for correspondence: Jozica &#x0160;iki&#x0107;, Klini&#x010D;ka bolnica &#x201C;Sveti Duh&#x201D;, Sveti Duh 64, HR-10000 Zagreb, Croatia. / Phone: +385-98-807-909 / E-mail: <email xlink:href="josicas1@gmail.com">josicas1@gmail.com</email></corresp></author-notes>
<pub-date pub-type="epub-ppub"><month>11</month><year>2016</year></pub-date>
<volume>11</volume>
<issue>10-11</issue>
<fpage>407</fpage>
<lpage>407</lpage>
<history>
<date date-type="received"><day>25</day><month>09</month><year>2016</year></date><date date-type="accepted"><day>10</day><month>10</month><year>2016</year></date>
</history>
<permissions>
<copyright-year>2016</copyright-year>
<copyright-holder>Croatian Cardiac Society</copyright-holder>
</permissions>
<kwd-group kwd-group-type="author"><title>Keywords: </title><kwd>heart failure</kwd><kwd>dilated cardiomyopathy</kwd><kwd>left ventricular assist device</kwd></kwd-group>
</article-meta>
</front>
<body>
<p>We present a case of Heart Mate 3 (HM 3) (<xref ref-type="bibr" rid="r1"><italic>1</italic></xref>) explant after recovery of heart function eight months after implantation. Our patient is 60-year-old man with left side heart failure symptoms since September 2014. At the time he had atrial fibrillation and no other comorbidities. Initial echocardiographic finding was severe left ventricular impairment (left ventricular diastolic diameter - LVEDD 6.4 cm; reduced left ventricular ejection fraction - LVEF 20%). Initial coronarography exposed non-significant left anterior descending (LAD) artery stenosis. Despite optimal medicamentous treatment the patient suffered from repetitive non sustained ventricular tachycardias and had intracardiac defibrillator implanted in June 2015. Persistent left ventricular failure required implantation of the left ventricular assisted device - LVAD. The patient was followed during monthly external consultation, including device inspection, clinical examination and transthoracic echocardiography. Follow-up revealed clinical improvement with recovery of myocardial activity at echocardiography. On postoperative month 7, the echocardiography confirmed ventricular function improvement with an LVEF 50-55%. These led to the decision to remove the assist device. The weaning protocol included in-hospital evaluation consisting of echocardiography and hemodynamic measurements. Testing of cardiac function was performed under regular pump support (step 1), minimal LVAD support (step 2) and pump stop with balloon occlusion of outflow graft (step 3). Step 1 was performed one month prior to explantation (LVEF 50%, LVEDD 5.2 cm, VO<sub>2</sub> 19 ml/min/kg, PCWP 14 mmHg). Step 2 was preformed 2 days prior to explantation (LVEF 50%, LVEDD 5.4 cm, VO<sub>2</sub> 18 ml/min/kg, PCWP 15 mmHg). The final 3rd step was performed in the hybrid operating theatre with pump stop and balloon occlusion of outflow graft. After confirming preserved left ventricular function with TEE and hemodynamic measurements (preserved LVEF, CO 4.3-5.0 L/min, PCWP 14 mmHg, SVO<sub>2</sub> 80%) final decision was made to proceed with explantation immediately thereafter. The patient fully recovered after surgery. His postoperative echocardiography showed normal ejection fraction, with no heart cavities dilatation. Patient has been discharged 20 days after HM 3 explant in a good condition.</p>
</body>
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<ref-list>
<title>Literature</title>
<ref id="r1"><label>1</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dandel</surname><given-names>M</given-names></name><name><surname>Weng</surname><given-names>Y</given-names></name><name><surname>Siniawski</surname><given-names>H</given-names></name><name><surname>Potapov</surname><given-names>E</given-names></name><name><surname>Lehmkuhl</surname><given-names>HB</given-names></name><name><surname>Hetzer</surname><given-names>R</given-names></name></person-group>. <article-title>Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices.</article-title> <source>Circulation</source>. <year>2005</year>;<volume>112</volume>(<issue>9</issue>) <supplement>Suppl</supplement>:<fpage>I37</fpage>&#x2013;<lpage>45</lpage>. <pub-id pub-id-type="doi">10.1161/CIRCULATIONAHA.104.525352</pub-id><pub-id pub-id-type="pmid">16159848</pub-id></mixed-citation></ref>
</ref-list>
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</article>
