Mechanical circulatory support as bridge to urgent structural intervention

Mechanical circulatory support as bridge to urgent structural intervention Cardiovascular flashlight 1 doi:10.1093/eurheartj/ehy110 CARDIOVASCULAR FLASHLIGHT .................................................................................................................................................... Patrick Horn, Malte Kelm, and Ralf Westenfeld* Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Du¨sseldorf, Moorenstr. 5, D-40225 Du¨sseldorf, Germany * Corresponding author. Tel: 149 211 8118800, Fax: 149 211 8118812, Email: ralf.westenfeld@med.uni-duesseldorf.de A 79-year-old woman was admitted in the emergency depart- ment as late comer in cardiogenic shock due to subacute non- ST-elevation myocardial infarction, which clinically occurred 8 days prior. Coronary angiography depicted occlusion of a small circumflex artery. Revascularization was deemed unreasonable in the light of normal CK and elevated LDH/troponin serum lev- els. The patient was haemodynamically compromised with ele- vated lactate and imminent renal and liver failure. Acute Physiology and Chronic Health Evaluation (APACHE II) Score was 25 points corresponding to an in-hospital mortality of 51%. Percutaneous mechanical circulatory support (Impella CP) was implanted and haemodynamics stabilized over 48 h along with recovery of renal as well as liver function. However, cardiac func- tional recovery was hampered by severe mitral regurgitation (MR) with concomitant prolapse of the posterior leaflet. Our Heart Team decision was to perform percutaneous mitral valve repair with the MitraClip system under Impella support (Panel A). Prior to MitraClip, left atrial pressure (LAP) was elevated indi- cating severe MR. As the performance level of the Impella was decreased, systemic arterial pressure decreased, and LAP even further increased (Panel B). Implantation of two clips reduced MR to a mild degree, and the dependence of LAP on systemic ar- terial pressure and Impella support was attenuated (Panel C). The Impella was weaned and explanted the same day. The pa- tient was discharged at New York Heart Association (NYHA) II 7 days after admission. This case is the first report of a critically ill patient bridged by mechanical circulatory support to urgent percutaneous mitral repair. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehy110/4931201 by Ed 'DeepDyve' Gillespie user on 08 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Mechanical circulatory support as bridge to urgent structural intervention

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Oxford University Press
Copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
ISSN
0195-668X
eISSN
1522-9645
D.O.I.
10.1093/eurheartj/ehy110
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Abstract

Cardiovascular flashlight 1 doi:10.1093/eurheartj/ehy110 CARDIOVASCULAR FLASHLIGHT .................................................................................................................................................... Patrick Horn, Malte Kelm, and Ralf Westenfeld* Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Du¨sseldorf, Moorenstr. 5, D-40225 Du¨sseldorf, Germany * Corresponding author. Tel: 149 211 8118800, Fax: 149 211 8118812, Email: ralf.westenfeld@med.uni-duesseldorf.de A 79-year-old woman was admitted in the emergency depart- ment as late comer in cardiogenic shock due to subacute non- ST-elevation myocardial infarction, which clinically occurred 8 days prior. Coronary angiography depicted occlusion of a small circumflex artery. Revascularization was deemed unreasonable in the light of normal CK and elevated LDH/troponin serum lev- els. The patient was haemodynamically compromised with ele- vated lactate and imminent renal and liver failure. Acute Physiology and Chronic Health Evaluation (APACHE II) Score was 25 points corresponding to an in-hospital mortality of 51%. Percutaneous mechanical circulatory support (Impella CP) was implanted and haemodynamics stabilized over 48 h along with recovery of renal as well as liver function. However, cardiac func- tional recovery was hampered by severe mitral regurgitation (MR) with concomitant prolapse of the posterior leaflet. Our Heart Team decision was to perform percutaneous mitral valve repair with the MitraClip system under Impella support (Panel A). Prior to MitraClip, left atrial pressure (LAP) was elevated indi- cating severe MR. As the performance level of the Impella was decreased, systemic arterial pressure decreased, and LAP even further increased (Panel B). Implantation of two clips reduced MR to a mild degree, and the dependence of LAP on systemic ar- terial pressure and Impella support was attenuated (Panel C). The Impella was weaned and explanted the same day. The pa- tient was discharged at New York Heart Association (NYHA) II 7 days after admission. This case is the first report of a critically ill patient bridged by mechanical circulatory support to urgent percutaneous mitral repair. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehy110/4931201 by Ed 'DeepDyve' Gillespie user on 08 June 2018

Journal

European Heart JournalOxford University Press

Published: Mar 12, 2018

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