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Multimodal mechanical circulatory assist for perioperative biventricular failure
Yukiharu Sugimura1, Arash Mehdiani1, Hug Aubin1
1Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
Journal of Cardiac Surgery
|December 7, 2020
Summary
This case study shows how mechanical circulatory support systems can successfully treat biventricular decompensation after myocardial infarction. An adaptive weaning strategy using Impella and TandemHeart provided crucial support during recovery.
Area of Science:
- Cardiology
- Critical Care Medicine
- Mechanical Circulatory Support
Background:
- Acute myocardial infarction (MI) can lead to severe biventricular decompensation and cardiogenic shock.
- Mechanical circulatory support (MCS) is vital for managing cardiogenic shock post-MI.
- Sequential MCS deployment allows for tailored hemodynamic support and weaning strategies.
Observation:
- A 61-year-old female patient experienced cardiogenic shock post-MI requiring initial Impella CP support.
- Post-coronary artery bypass grafting (CABG), venous-arterial extracorporeal membrane oxygenation (va-ECMO) was initiated.
- The patient subsequently required Impella 5.0 and TandemHeart for biventricular support due to inadequate flow.
Findings:
- A sequential MCS strategy involving Impella CP, va-ECMO, Impella 5.0, and TandemHeart was successfully implemented.
- The combination of Impella 5.0 and TandemHeart facilitated va-ECMO weaning.
- Both devices were weaned successfully, with Impella removed on postoperative day 14 and TandemHeart on postoperative day 31.
Implications:
- This case demonstrates the successful application of a sequential and adaptive MCS strategy for biventricular failure post-MI.
- Such strategies can improve outcomes in complex cardiogenic shock patients.
- Tailored MCS management is crucial for achieving hemodynamic stability and facilitating recovery.
Keywords:
ImpellaTandemheartcardiogenic shockextracorporeal membrane oxygenationmultimodal mechanical circulatory assistMore Related Videos
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