A Case of Open Cholecystectomy for Acute Cholecystitis in a Patient with an Implanted Left Ventricular Assist Device on the Waiting List for a Deceased Donor Heart Transplantation

Le résumé fourni par la source

INTRODUCTION: Left ventricular assist devices (LVADs) are increasingly used as bridge-to-transplant or destination therapy for patients with advanced heart failure. As long-term survival improves, more recipients encounter noncardiac surgical conditions. Acute cholecystitis is one of the most common abdominal emergencies in this population and presents unique challenges due to continuous anticoagulation, altered hemodynamic physiology under continuous-flow support, and the presence of pump hardware and drivelines. Delay in treatment risks systemic infection or device contamination, potentially jeopardizing heart transplant eligibility. However, evidence guiding optimal surgical management in patients with prolonged LVAD support remains limited. CASE PRESENTATION: A man in his 50s with a 6-year history of HeartMate II (Abbott Laboratories, Abbott Park, IL, USA) support presented with fever and right upper quadrant abdominal pain while waiting for deceased donor heart transplantation. Imaging confirmed acute cholecystitis with gallstones. Because of the physiological risks associated with pneumoperitoneum and the need for ongoing anticoagulation, percutaneous transhepatic gallbladder drainage (PTGBD) was performed first, leading to effective infection control. As prolonged catheter placement was undesirable in a transplant candidate, he subsequently underwent elective open cholecystectomy after multidisciplinary planning, perioperative anticoagulation adjustment with heparin bridging, and preoperative US mapping of the driveline. The operation was completed without device injury, uncontrollable bleeding, or hemodynamic instability. The postoperative course was uneventful, and the patient successfully underwent heart transplantation 4 months later. CONCLUSIONS: This case demonstrates that a staged strategy consisting of early infection control followed by elective cholecystectomy can be safely applied in LVAD-supported patients awaiting heart transplantation. Individualized perioperative planning, optimized anticoagulation management, and precise assessment of driveline anatomy are essential to ensure surgical safety and to preserve transplant eligibility in this high-risk population.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.