Impella support as a bridge to scheduled surgical repair of ventricular septal rupture
- PDF / 1,329,481 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 79 Downloads / 228 Views
CASE REPORT Artificial Heart (Clinical)
Impella support as a bridge to scheduled surgical repair of ventricular septal rupture Makiko Nakamura1 · Teruhiko Imamura1 · Takuya Fukui1 · Youhei Ueno1 · Hiroshi Ueno1 · Shigeki Yokoyama2 · Toshio Doi2 · Kazuaki Fukahara2 · Koichiro Kinugawa1 Received: 2 December 2019 / Accepted: 11 March 2020 © The Japanese Society for Artificial Organs 2020
Abstract We studied the experience of a 69-year-old woman with acute decompensated heart failure due to post-infarction ventricular septal rupture. She received mechanical hemodynamic support by Impella 2.5 (Abiomed, Danvers, MA, USA), percutaneous axial-flow left ventricular assist device, which improved intra-cardiac pressure, maintaining end-organ function. She was successfully bridged to the scheduled surgical repair of ventricular septal rupture following the 9-day Impella support and discharged on foot on the 32nd day. Impella might be a useful mechanical circulatory support device as a bridge tool to the scheduled surgical repair of ventricular septal rupture if used with careful daily management to prevent device-related comorbidities. Keywords Cardiogenic shock · Ventricular assist device · STEMI · Mechanical complication
Introduction Mechanical complications following ST-elevation myocardial infarction (STEMI) are life-threatening and require prompt management. Ventricular septal rupture (VSR) develops as a rapid-onset hemodynamic deterioration occurring during the subacute phase, i.e., within 24 h to several days after myocardial infarction (MI), owing to the necrosis of ventricular septum [1]. Repair of the VSR should be performed in all patients even if clinically stable, given the size of the septal rupture can increase if left unrepaired. However, the optimal timing of the repair has not yet reached a consensus [1, 2]. Literature reviews show that urgent surgery is associated with a high mortality rate (30–60%) [3, 4], whereas a delayed and scheduled surgery seems to have a better outcome,
* Teruhiko Imamura [email protected]‑toyama.ac.jp 1
The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930‑0194, Japan
Department of Cardiovascular Surgery, University of Toyama, Toyama, Japan
2
minimizing the mortality rate down to 15% [4, 5]. Percutaneous closure of VSR might be an alternative option, although requiring further investigations [6]. Thus far, it is unknown how we maintain hemodynamics of the patients with VSR until the scheduled surgical repair. Intra-aortic balloon pump (IABP) has conventionally been used as a bridge tool [5], but it is insufficient to maintain hemodynamics in most cases. Recently, Impella (Abiomed, Danvers, MA, USA), percutaneous axial-flow left ventricular assist devices (LVADs), has been introduced as a promising bridge tool to transiently support patients’ hemodynamics [7]. In this report, we present a patient with VSR who received Impella 2.5 support as a bridge tool to the scheduled and successful surgical repair.
Case report Before admis
Data Loading...
