Left Ventricular Assist Device Use as a Bridge to Heart Transplantation in Restrictive Cardiomyopathy: A Series of 2 Cases

Restrictive cardiomyopathy (RCM) is associated with a high mortality rate among patients awaiting heart transplantation, largely due to the challenges inherent in mechanical circulatory support device implantation and the limited effectiveness of pharmacologic therapies. The small size of the left ventricular cavity in RCM patients can cause significant complications, such as inflow cannula obstruction, impaired diastolic filling, and an increased risk of suction events. Here, we present 2 cases, each rare individually, both of which posed unique surgical challenges. Our aim was to evaluate the preoperative conditions, clinical characteristics, surgical approaches, and early outcomes in 2 RCM patients: one who received a left ventricular assist device (LVAD) as a bridge to heart transplantation, and the other as a bridge to candidacy. For the first patient, LVAD implantation with mitral valve resection was performed under emergency conditions due to the presence of a left atrial thrombus; subsequent heart transplantation was later achieved. For the second patient, LVAD implantation with mitral valve replacement was conducted as a bridge to candidacy in the setting of high pulmonary vascular resistance.