Beta-Thalassemia Major With Iron Overload Cardiomyopathy and Refractory Cardiogenic Shock Requiring Mechanical Circulatory Support

Despite the prevalence of thalassemia worldwide, there is minimal literature on advanced heart failure and cardiogenic shock due to iron overload cardiomyopathy. We report a novel case of thalassemia with iron overload cardiomyopathy in an adult, who improved on iron chelation and implantation of a HeartMate 3 left ventricular assist device (Abbott) as a bridge to recovery. Mechanical circulatory support in thalassemia is lifesaving but complex, with unique challenges. These include balancing bleeding and thrombotic risks, adjusting mechanical circulatory support flow to minimize hemolysis while optimizing hemodynamics, mitigating infection risk despite immunocompromise, and using serial ferritin and echocardiography instead of cardiac magnetic resonance imaging to assess myocardial recovery.