# Use of LVAD HeartMate 3 and Impella RP in the management of advanced heart failure in an elderly patient: a case report

## TL;DR

This case report details the complex treatment of an elderly patient with advanced heart failure using mechanical circulatory support devices and highlights the challenges and complications involved.

## Contribution

The paper provides a detailed clinical case illustrating the use and complications of LVAD and Impella RP in elderly patients with advanced heart failure.

## Key findings

- LVAD implantation was complicated by recurrent cardiac tamponade and right heart failure.
- The patient experienced multiple complications including infections, sepsis, and multiorgan failure.
- Palliative care was transitioned to home-based due to progressive multiorgan failure and severe cachexia.

## Abstract

Heart failure (HF) is a leading cause of morbidity and mortality. Mechanical circulatory support (MCS), such as the HeartMate 3 left ventricular assist device (LVAD), is a therapeutic option for patients who are ineligible for heart transplantation. Right heart failure (RHF), depending on the clinical criteria applied for its diagnosis, occurs in 10–40% of patients following LVAD implantation and significantly worsens prognosis. This report presents a 69-year-old male with chronic ischemic HF, prior cardiac resynchronization therapy with defibrillator (CRT-D) implantation, and coronary intervention with drug-eluting stents. Due to progressive mitral regurgitation (MR) and elevated HF biomarkers, MitraClip implantation was performed with initial clinical improvement. Subsequently, left ventricular function deteriorated despite optimized pharmacotherapy, leading to HeartMate 3 LVAD implantation. The postoperative course was complicated by recurrent cardiac tamponade requiring surgical management. Progressive RHF necessitated temporary support with an Impella RP device. Further complications included recurrent infections, sepsis, respiratory failure, and acute kidney injury requiring renal replacement therapy. Despite comprehensive treatment, progressive multiorgan failure and severe cachexia developed. Given the patient’s status as a destination therapy, care was transitioned to home-based palliative management. This case illustrates the complexity of managing end-stage HF with LVAD support, highlighting the frequent complications such as RHF and infections, and the importance of recognizing when to prioritize comfort in advanced disease.