Bowel obstruction due to retained intraperitoneal left ventricular assist device (LVAD) driveline

Daniel Miklin, Ivy Lewis, Howard Lieberman

Left ventricular assist devices (LVAD) provide a lifesaving bridge to cardiac transplant. Utilization of these devices is increasing in the United States. When a patient undergoes cardiac transplant, the left ventricular device is surgically removed and the driveline is extracted or left tunneled in the subcutaneous tissue. Our group encountered a rare and previously unreported complication of this device: intraperitoneal infiltration of a retained driveline after cardiac transplant causing a small bowel obstruction. A 62 year old male with a past medical history of non-ischemic cardiomyopathy induced heart failure, status post bridging left ventricular assist device and orthotopic heart transplant presented with abdominal distention, tenderness, and leukocytosis six days post-transplant. CT abdomen and pelvis revealed dilated loops of bowel, air-fluid levels and a transition point in the proximal small bowel. The patient was diagnosed with small bowel obstruction and taken for exploratory laparotomy. He was found to have a retained intraabdominal LVAD driveline strangulating a loop of small bowel in the left upper quadrant. The driveline was removed and the section of bowel released with return of perfusion. We had encountered a rare complication of retained left ventricular assist device driveline after cardiac transplant: inadvertent penetration into the peritoneal cavity resulting in strangulation of small bowel. This complication, though uncommon, provides substantial risk to patients previously treated with left ventricular assist devices. Meticulous care must be taken to ensure proper device insertion and extraction, as well as consideration of this etiology when patients present with bowel obstruction after cardiac transplant.