Antepartum Temporary Heart Pump Placement to Support Delivery and Bridge to Transplant

With advances in technology, temporary mechanical circulatory support (tMCS) devices have increasingly been used to treat patients in cardiogenic shock.

A 25-year-old G1P0 woman with known idiopathic dilated cardiomyopathy since infancy was hospitalized with acute on chronic decompensated heart failure (HF) at 30 weeks of gestation and bridged to delivery and heart transplantation with an Impella CP heart pump.

There is a dearth of experience in use of tMCS for patients experiencing peripartum HF reported in the literature and significant uncertainty over the use of anticoagulation antepartum. This case addresses both antepartum heart pump use and a safe anticoagulation strategy with tMCS in pregnancy.

This case is the first reported experience to our knowledge that antepartum Impella heart pump placement with anticoagulation is safe and effective for supporting both mother and fetus to delivery and subsequent heart transplantation for the mother in pregnancy-associated acute decompensated HF. Both mother and baby in this case had successful outcomes.