Cardiogenic shock in pregnancy: Prolonged axillary Impella 5.5 support during pregnancy and postpartum as bridge to...

Cardiogenic shock during pregnancy carries substantial maternal and fetal morbidity and mortality, and guidance on temporary mechanical circulatory support (tMCS) in this setting remains limited.

A 36-year-old woman at 21 weeks' gestation presented with severe dilated cardiomyopathy (ejection fraction 20%, LVIDd 8.0 cm), cardiogenic shock (cardiac index 1.7 L/min/m²), and recurrent ventricular arrhythmias. She declined termination of pregnancy. An axillary Impella 5.5 was placed for hemodynamic stabilization with rapid improvement in cardiac output and filling pressures. Progressive ventricular arrhythmias at 23 weeks and 3 days necessitated urgent cesarean delivery; the neonate did not survive. The patient was supported with the Impella 5.5 for 66 days and underwent successful orthotopic heart transplantation.

To our knowledge, this is one of the longest reported durations of Impella 5.5 support initiated during pregnancy and continued into the postpartum period. This case highlights important considerations that may inform individualized multidisciplinary decision-making on temporary mechanical circulatory support selection in pregnancy-associated cardiogenic shock.