One Pump for Two Hearts: Using an Impella 5.5 Micro-Axial Pump in Peripartum Cardiogenic Shock.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
19 Apr 2024
19 Apr 2024
Historique:
medline:
18
4
2024
pubmed:
18
4
2024
entrez:
18
4
2024
Statut:
aheadofprint
Résumé
Cardiogenic shock (CS) occurs infrequently in pregnancy and has a high mortality rate. Medical treatment options are few, with limited evidence of efficacy. Temporary mechanical circulatory supports (tMCS) may play a key role in addressing this therapeutic lacuna. We report successfully managing second-trimester CS using an Impella 5.5 micro-axial pump. Our patient presented in the second-trimester with CS. Hemodynamic parameters indicated biventricular dysfunction (low cardiac index, low pulmonary artery pulsatility index). She received diuresis and inotropic support to optimize her fluid status and cardiac function. However, failure to improve to the point where she would be able to tolerate the hemodynamic stresses of labor despite optimizing medical therapy prompted consideration of tMCS. The Impella 5.5 was chosen for its higher output (to maximize fetal perfusion), relative longevity, and lower hemolysis rates compared to other devices. It was used to support her from gestational weeks 28-30 and through the delivery. Support was continued for 4 weeks postpartum to allow for any potential cardiac recovery. Hope unrealized, a workup for destination therapy was initiated. Patient preference and high panel reactive antibodies informed the decision to pursue destination left ventricular assist device (LVAD) therapy. After a 3 month neonatal intensive care unit (NICU) stay, mother and baby were successfully discharged home.
Identifiants
pubmed: 38635520
doi: 10.1097/MAT.0000000000002215
pii: 00002480-990000000-00472
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © ASAIO 2024.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
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Caruso G, Scopelliti A, Scaramuzzino S, et al.: Cabergoline as an adjuvant to standard heart failure treatment in peripartum cardiomyopathy: A case report and review of the literature. Case Rep Womens Health 29: e00277, 2021.
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Ramzy D, Soltesz EG, Silvestry S, Daneshmand M, Kanwar M, D’Alessandro DA: Improved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients. J Heart Lung Transplant 42: 553–557, 2023.
Shugh S, Chrisant M, D’Addese L, Turner I, Bibevski S, Scholl F: Successful implantation of Impella 5.5 device and subsequent recovery in a pediatric patient with small arterial vessels. J Heart Lung Transplant 40: S523–S524, 2021.
Elkayam U, Schäfer A, Chieffo A, et al.: Use of Impella heart pump for management of women with peripartum cardiogenic shock. Clin Cardiol 42: 974–981, 2019.