Laparotomy for Acute Cholecystitis after Extracorporeal Left Ventricular Assisted System Implantation

Abstract

A 37-year-old man presented with extensive myocardial infarction due to total occlusion of the left main trunk, complicated with near-fatal heart failure. An extracorporeal left ventricular assisted system LVAS (NIPRO-Toyobo LVAS) was implanted in our hospital. Although his postoperative course was relatively good, acute cholecystitis occurred on the 31st postoperative day, and emergeney cholecystectomy was indicated. His PT-INR was 4.13 because of taking Warfarin orally, and the cannulas of LVAS passed through his skin at the subxiphoid region. Therefore, we preoperatively transfused fresh frozen plasma quickly to reverse the PT-INR (approximately 2.0) and performed open cholecystectomy via the right side of the para-rectus abdominal muscle. His postoperative course was uneventful, and he is waiting for heart transplantation in our hospital.