MoyoAssist® Bridges a patient with advanced acute heart failure to Successful Transplantation

A multidisciplinary team at The First Affiliated Hospital of Guangzhou Medical University successfully utilized MoyoAssist® , an extracorporeal magnetically levitated ventricular assist device, to provide circulatory support for a critically ill patient with acute heart failure following PCI due to myocardial infarction. The device served as a bridge to transplantation, enabling stable hemodynamics during the pre-transplant period and ultimately contributing to a successful heart transplant.

Patient Profile

Age: 67 years

Gender: Male

Clinical history: Recurrent chest tightness for 6 months, worsened over the past 10 days

Underlying conditions:

• Acute ST-segment elevation myocardial infarction (Killip Class IV)

• End-stage heart failure (NYHA Class IV)

• Left main and triple-vessel coronary artery disease

• Acute renal failure

• Klebsiella pneumonia

• Type 2 diabetes mellitus

• Hypertension (Grade 2, very high risk)

• History of cerebral infarction, fatty liver, gallstones

Clinical Evaluation

ECG findings: Sinus rhythm, complete left bundle branch block, QRS prolongation, abnormal Q waves

Biomarkers:

• CK: 724 U/L ↑

• CK-MB: 60.0 U/L ↑

• Troponin T: 1050.00 ng/L ↑

• NT-proBNP: 8348.00 pg/mL ↑

Coronary angiography:

• Severe multivessel stenosis

• LM 60%-80% stenosis with diffused lesions

• Proximal-mid LAD nearly occlusion, TIMI 0

• Proximal-mid LCX 90% stenosis, TIMI 3

• Mid-RCA occlusion, proximal RCA 30%-80% stenosis with diffused lesions,TIMI 0

• TIMI 0–3 flow in affected vessels

Treatment Strategy

Given the patient's severe condition and contraindications for conventional circulatory support which deployed through intervention approach (such as ECMO and IABP) due to poor peripheral vascular access, the clinical team selected MoyoAssist® as a mechanical circulatory support option. This approach aimed at:

• Unload the failing heart

• Restore end-organ perfusion

• Maintain stability while awaiting a suitable donor organ

Surgical Procedure

Approach: Median sternotomy under general anesthesia

Cannulation: Right superior pulmonary vein (drainage) and ascending aorta (perfusion)

Device placement:

• MoyoAssist® was primed to eliminate air and connected to extracorporeal circulation

• Real-time adjustment of pump speed, negative pressure, and outflow pressure ensured optimal flow dynamics without hemolysis or embolism

• Left and right atrial pressures were closely monitored to balance hemodynamics

Postoperative Course

• The patient was admitted to the ICU for ongoing monitoring and supportive care

• Approximately one week post-implantation, a suitable donor heart was identified

• The patient underwent a successful heart transplantation and continued to recover well

Clinical Reflections

Surgical challenges:

• Cardiogenic shock and vascular fragility necessitated open surgical access

Device advantages:

• Provided effective circulatory support in a setting when intervention options were limited

• Enabled safe stabilization and improved transplant candidacy

Considerations for future practice:

• Optimal anticoagulation protocols post-implantation require further investigation to minimize bleeding risks while ensuring device patency

This case highlights the potential of magnetically levitated extracorporeal VADs in bridging critically ill patients to definitive therapies such as transplantation, particularly when conventional support modalities are contraindicated. MoyoAssist® continues to expand therapeutic options for complex heart failure management in real-world clinical settings.