Case Reports

Successful Implantation of a Left Ventricular Assist Device in a Patient with Heparin-Induced Thrombocytopenia and Thrombosis

Address correspondence to: Cassandra Garland, CCP, LP, Care of David Somogyi, CCP, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: cassiemgarland@gmail.com

Received: 25 April 2013
Accepted: 2 May 2014

Abstract

We report the case of a 27-year-old woman with signs of heparin-induced thrombocytopenia and thrombosis (HITT) and left heart failure presenting for urgent implantation of a left ventricular assist device (LVAD). HITT can occur in 4.2–6.1% of patients with LVADs. If the patient remains hemodynamically stable, implantation can be delayed for several months until the heparin/PF-4 antibodies decline allowing the use of heparin on cardiopulmonary bypass, However, in most cases related to cardiogenic shock, surgery cannot be delayed. We present the case of a patient who underwent implantation of a HeartMate II LVAD and discuss management strategy using bivalirudin during cardiopulmonary bypass.