Mechanical circulatory support for haemodynamic protection in patients with heart failure during non-cardiac surgery

The prevalence of heart failure and the rate of surgical interventions are increasing worldwide, leading to a rising number of patients with heart failure who are at high perioperative risk. We analyzed the value of mechanical circulatory support (MCS) in patients with severe cardiac impairment who underwent non-cardiac surgery.

Single center retrospective analysis of 5 patients undergoing non-cardiac surgery (NCS) protected by MCS.

Four patients with cardiogenic shock underwent NCS (gland resection, n = 4) protected by veno-arterial extracorporeal membrane oxygenation and an Impella CP microaxial pump. Elective Surgical thyroidectomy under hemodynamic protection with Impella CP was performed in one patient with severe chronic heart failure.All patients initially survived the surgery, and mechanical circulatory support led to rapid lactate clearance. One patient died during follow-up due to advanced multiorgan failure, the remaining four patients could be successfully weaned from hemodynamic circulatory support. Notably, the patient with fatal outcomes had the longest delay between the onset of cardiogenic shock and initiation of MCS, while other patients with elective or rapid (<24 h) implantation of mechanical circulatory support had favorable outcomes.

MCS is a promising strategy in cardiogenic shock, enabling hemodynamic stabilization and protected surgery. Rapid initiation of MCS is important. This approach may be viable for selected patients with severe heart failure who require elective NCS. Findings are preliminary and hypothesis-generating, further validation is needed.