Fatal Non-aneurysmal Subarachnoid Haemorrhage During Bridge-to-Transplant Rehabilitation in a Patient With Biventricular Assist Devices.
- 1Medicine, University of Cambridge, Cambridge, GBR.
Abstract
Subarachnoid haemorrhage (SAH) is a rare but catastrophic complication in patients supported by biventricular assist devices (BiVADs). While mechanical circulatory support (MCS) is a life-saving bridge to transplantation, it introduces complex haemostatic challenges. We report the case of a 32-year-old male with hypertrophic cardiomyopathy who developed cardiogenic shock. He was bridged from central veno-arterial extracorporeal membrane oxygenation (cVA-ECMO) to BiVAD support. His clinical course was complicated by suspected heparin-induced thrombocytopaenia (HIT), but further testing proved he was HIT negative. After weeks of haemodynamic stability and the commencement of physical rehabilitation for heart transplant listing, the patient suffered a sudden and profound neurological decline. Imaging revealed a diffuse, non-aneurysmal SAH occupying the basal cisterns. Neurosurgical intervention included placement of an external ventricular drain; however, he further declined, and support was withdrawn. This case highlights the challenging haemostatic landscape inherent to ventricular assist devices (VADs), where standard laboratory tests fail to reflect profound functional coagulopathy. Ultimately, this case serves as a critical reminder that BiVADs create a challenging haemostatic environment that demands more sophisticated solutions.
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BibTeX
@article{youssef2026fatal,
title = {{Fatal Non-aneurysmal Subarachnoid Haemorrhage During Bridge-to-Transplant Rehabilitation in a Patient With Biventricular Assist Devices.}},
author = {Christopher Youssef},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117013},
url = {https://europepmc.org/article/MED/42948821},
note = {CC BY},
}
RIS
TY - JOUR
TI - Fatal Non-aneurysmal Subarachnoid Haemorrhage During Bridge-to-Transplant Rehabilitation in a Patient With Biventricular Assist Devices.
AU - Christopher Youssef
PY - 2026
DA - 2026/09/27
JO - Cureus
DO - 10.7759/cureus.117013
UR - https://europepmc.org/article/MED/42948821
AB - Subarachnoid haemorrhage (SAH) is a rare but catastrophic complication in patients supported by biventricular assist devices (BiVADs). While mechanical circulatory support (MCS) is a life-saving bridge to transplantation, it introduces complex haemostatic challenges. We report the case of a 32-year-old male with hypertrophic cardiomyopathy who developed cardiogenic shock. He was bridged from central veno-arterial extracorporeal membrane oxygenation (cVA-ECMO) to BiVAD support. His clinical course was complicated by suspected heparin-induced thrombocytopaenia (HIT), but further testing proved he was HIT negative. After weeks of haemodynamic stability and the commencement of physical rehabilitation for heart transplant listing, the patient suffered a sudden and profound neurological decline. Imaging revealed a diffuse, non-aneurysmal SAH occupying the basal cisterns. Neurosurgical intervention included placement of an external ventricular drain; however, he further declined, and support was withdrawn. This case highlights the challenging haemostatic landscape inherent to ventricular assist devices (VADs), where standard laboratory tests fail to reflect profound functional coagulopathy. Ultimately, this case serves as a critical reminder that BiVADs create a challenging haemostatic environment that demands more sophisticated solutions.
SN - 2168-8184
ER -