Abstract
We describe a 72-year-old man who could be weaned from left ventricular assist system (LVAS) to IABP using alternate synchronous driving method (ASDM), which was newly devised for smooth and safe weaning from LVAS. ASDM could drive IABP and LVAS alternately with electrocardiogram synchronization. During the weaning stage, ASDM increased IABP pumping ratio while decreasing LVAS pumping ratio according to recovery of the natural heart function. The patient had an episode of ventricular fibrillation caused by coronary spasm on the way to the ICU after coronary bypass grafting. Defibrillation was successful but acute myocardial infarction occurred. Extracorporeal circulation (ECC) was initiated again to maintain systemic circulation, but repeated attempts to wean from EGO failed even with IABP support. LVAS was then initiated with gradual increase in cardiac function during LVAS support. The patient however developed infection as well as renal and respiratory failure. In order to wean safely from LVAS, ASDM was actuated. The patient was weaned from LVAS to IABP without deterioration in systemic perfusion, and his organ function did not deteriorate during weaning process. ASDM proved to be useful and safe in weaning from LVAS without hemo-dynamic instability, and to evaluate cardiac function of the natural heart before removal of LVAS.
