[World's First] Case Discussion from PUMCH: The "Heart-Brain Co-treatment" Strategy for Synchronized LVAD Implantation and Intracranial Aneurysm Embolization

🧠 [World's First] Case Discussion from PUMCH: The "Heart-Brain Co-treatment" Strategy for Synchronized LVAD Implantation and Intracranial Aneurysm Embolization

Balancing the treatment needs of different organs in patients with high-risk, multi-system comorbidities remains a major clinical challenge. Recently, the team at Peking Union Medical College Hospital (PUMCH) completed the world's first synchronized LVAD implantation and intracranial aneurysm embolization in a Hybrid OR. I would like to share some technical reflections on this case.

💡 The Clinical Dilemma
The 61-year-old patient (LVEF 23%) faced both end-stage heart failure and a high-risk intracranial aneurysm. The core contradiction: LVAD relies on strict anticoagulation management, which exposes the untreated aneurysm to an extremely high risk of fatal rupture.

⚙️ The Solution: Breaking Silos with Synchronized Intervention
Traditional "treat one, risk the other" approaches or staged surgeries carry prohibitive risks. The team opted to integrate neuro-intervention and cardiac surgery workflows under a single anesthesia:

Preventing Brain Hemorrhage First: The neurosurgery team performed coil embolization to safely secure the aneurysm.
Treating Heart Failure Next: The cardiac surgery team immediately took over to complete CABG, AVR, and LVAD implantation.
Full-Process Quality Control: Intraoperative neuroangiography confirmed the embolization efficacy, while the anesthesia department ensured smooth hemodynamic transitions throughout.
⏱️ Postoperative Outcome
Through this one-stop MDT collaboration, the patient avoided the secondary trauma of staged surgeries, recovered rapidly, and was successfully discharged with stable LVAD support (2800 RPM).

🗣️ Colleague Discussion
This case demonstrates the technical advantages of the Hybrid OR in managing cross-disciplinary, complex critical care. To my colleagues globally: When facing such cardiovascular/cerebrovascular comorbidities with an absolute "anticoagulation vs. bleeding" contradiction, what MDT evaluation and intervention protocols does your center typically adopt? Welcome to share your clinical experiences in the comments below. 👇