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[Clinical experience of a percutaneous ventricular support for profound heart failure following acute myocardial
H Satoh1, T Kobayashi, T Hiraishi
1Department of Cardiovascular Surgery, Center for Adult Diseases, Osaka, Japan.
Insights
Percutaneous biventricular support effectively managed profound heart failure after myocardial infarction. This less invasive approach offers a promising alternative for critically ill patients requiring advanced cardiac support.
Area of Science:
- Cardiology
- Medical Devices
- Mechanical Circulatory Support
Background:
- Acute myocardial infarction can lead to profound heart failure, necessitating advanced circulatory support.
- Percutaneous cardiopulmonary support (PCPS) is utilized for acute cardiac events, but weaning can be challenging.
- Percutaneous left ventricular support (PLVS) offers a less invasive option for ventricular assistance.
Observation:
- A 59-year-old male with severe heart failure post-myocardial infarction required escalating support.
- Initial PCPS and intra-aortic balloon pump (IABP) failed to facilitate weaning.
- Transseptal left atrial cannulation for PLVS was insufficient, leading to recurrent cardiogenic shock.
Findings:
- Combined percutaneous biventricular support (PLVS + PCPS) provided a total assist flow of 3.4 L/min.
- Pulsatile pressure was achieved by incorporating IABP.
- Successful weaning from PCPS at 26 hours and PLVS at 118 hours was accomplished.
Implications:
- Percutaneous biventricular support is an effective, less invasive alternative to thoracotomy for profound heart failure.
- This combined approach may improve outcomes in patients with complex cardiac conditions.
- The technique demonstrates potential for managing refractory cardiogenic shock following acute myocardial infarction.
Abstract:
Percutaneous biventricular support with centrifugal pump was applied to a 59-year-old man with profound heart failure following acute myocardial infarction. Direct coronary angioplasty was performed under percutaneous cardiopulmonary support (PCPS). After angioplasty, he could not be weaned from PCPS under IABP. We used percutaneous left ventricular support (PLVS) with transseptal left atrial cannulation. PLVS could not maintain effective assist flow and he developed a cardiogenic shock again. PCPS was added to PLVS, and percutaneous biventricular support was started. Assist flow ranged 1.7-3.0 L/min in PLVS, and 1.7-2.0 L/min in PCPS, and total assist flow was 3.4 L/min. Pulsatile pressure was obtained by adding IABP. The patient was successfully weaned from PCPS in 26 hours and PLVS in 118 hours. Patient is alive and well one year after PLVS. Combination of PLVS and PCPS is an effective ventricular support system, being less invasive than conventional method with thoracotomy, and may be useful for profound heart failure.