Escalation from impella 5.5 to ECPELLA support as a bridge to mitral valve surgery in a patient with degenerative mitral regurgitation.
Vasiliki GregoryMatan GrunfeldArjun KanwalAtul D BaliStephen PanDavid SpielvogelMasashi KaiSuguru OhiraPublished in: Perfusion (2023)
Severe mitral regurgitation (MR) is an important cause of acute heart failure and significant contributor to morbidity and mortality. Mechanical circulatory support (MCS) devices such as Impella are readily used to hemodynamically stabilize patients with cardiogenic shock (CS) secondary to this valvular pathology. Impella can also be combined with VA-ECMO to an "ECPELLA" configuration if further escalation of hemodynamic support is needed. We report a case of a 57-year-old female who presented with CS secondary to a perforated anterior mitral valve leaflet and non-ischemic cardiomyopathy that did not stabilize with initial choice of Impella 5.5. She required further escalation from axillary Impella 5.5 to the combined ECPELLA configuration, which allowed hemodynamic stabilization and ultimately a successful high-risk isolated mitral valve replacement. Despite adequate Impella flow, escalation to a combined MCS configuration, such as ECPELLA, may need to be considered upfront for acute valvular insufficiency in the setting of pre-existing cardiomyopathy.
Keyphrases
- mitral valve
- extracorporeal membrane oxygenation
- respiratory failure
- left ventricular assist device
- acute respiratory distress syndrome
- left atrial
- left ventricular
- heart failure
- open label
- acute heart failure
- atrial fibrillation
- squamous cell carcinoma
- early onset
- liver failure
- radiation therapy
- mechanical ventilation
- lymph node
- oxidative stress
- brain injury
- magnetic resonance
- magnetic resonance imaging
- case report
- sentinel lymph node
- ultrasound guided
- decision making
- locally advanced
- early stage
- coronary artery bypass