A Rare Outcome and a Deadly Consequence: A Case Comparison Demonstrating the Importance of Early Transfer to an Advanced Heart Failure Center

Document Type

Conference Proceeding

Publication Date

3-2026

Publication Title

Journal of the American College of Cardiology

Abstract

Background: One common challenge with advanced heart failure patients is when to transfer to an advanced heart failure center (AHFC), a decision balancing the burden of transfer against the risks of delayed care. Two patients with new-onset heart failure in the setting of severe aortic stenosis (AS) were transferred to an AHFC; patient A transferred early, and patient B transferred late.

Case: Patient A is a 45-year-old male with a history of tobacco and cocaine use who presented to the ED in cardiogenic shock. Echo revealed LVEF of 20% with severe AS. He underwent durable left ventricular assist device (LVAD) placement and aortic valve replacement (AVR) at an AHFC. He remained abstinent from substance use, his medical therapy was titrated outpatient with recovery of his LVEF, and his LVAD was successfully explanted 14 months later. Patient B is a 55-year-old male with a history of a bicuspid aortic valve with moderate stenosis who presented to the ED with dyspnea. Echo revealed LVEF of 20% with now severe AS. He was transferred to a non-AHFC where he underwent AVR. Three weeks later he was admitted with a tachyarrhythmia and cardiogenic shock complicated by cardiac arrest. After 48 hours, the patient was transferred to an AHFC. Despite advanced interventions, the patient continued to deteriorate and died three weeks later.

Decision-Making: Care needs to be taken to judiciously select appropriate patients for transfer, as only 5.5% of hospitals qualify as an AHFC. We argue that patient B would have benefitted from transfer to an AHFC as pre-operative consultation may have been valuable in helping with surgical planning, risk stratification, and being optimally prepared for post-operative complications. There are only case reports demonstrating left ventricular recovery in patients that underwent LVAD placement at the same time as AVR, demonstrating patient A’s outcome as exceedingly rare. LVAD explant in general is uncommon, occurring in approximately 3%-6% of cases.

Conclusion: In patients with advanced heart failure and high-risk features at a non-AHFC, a specialist at an AHFC should be promptly consulted to maximize potential benefits and minimize potential harm.

Volume

87

Issue

13 Suppl

First Page

A1488

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1488

DOI

10.1016/j.jacc.2026.02.3708

ISSN

0735-1097

Link to Full Text

Share

COinS