ID:141 FC-PC1-9 Successful mechanical circulatory support for cardiogenic shock following tricuspid valve replacement in congenitally corrected transposition of the great arteries: A case report

Background: In patients with congenitally corrected transposition of the great arteries (ccTGA), dysfunction of the anatomical right ventricle (sRV) supporting the systemic circulation is a critical complication. While the utility of mechanical circulatory support (MCS) for cardiogenic shock has become widely recognized, reports of its use in ccTGA remain rare. We report a successful case of Impella initiation for cardiogenic shock due to sRV failure following tricuspid valve replacement (TVR) in a patient with ccTGA. Clinical Course: A 55-year-old with ccTGA (pulmonary atresia, ventricular septal defect, and pulmonary hypoplasia) had previously undergone a Rastelli procedure at the age of 8y. She was admitted with shortness of breath. Evaluations revealed severe tricuspid regurgitation with a reduced systemic right ventricular ejection fraction, mild stenosis of the LV-PA conduit, and pacemaker failure. She subsequently underwent TVR, LV-PA conduit replacement, and pacemaker lead replacement without any complications. On postoperative day 6, her respiratory status deteriorated due to worsening sRV dysfunction, accompanied by signs of multi-organ failure. The heart team decided to initiate Impella support. After initiation, stable hemodynamics were achieved, with improvement in lactate levels and increased urine output. Although moderate-to-severe aortic regurgitation (AR) developed, it did not compromise hemodynamics. The patient was successfully weaned from Impella four days after initiation. Discussion: The moderate-to-severe AR was likely caused by the anterior displacement of the aortic valve by the Impella catheter, reflecting the unique anatomical relationship between the aorta and pulmonary artery in ccTGA. If this AR had compromised hemodynamics, alternative MCS might have been required. Conclusion: In patients with sRV failure in ccTGA, Impella may represent a feasible and effective option for hemodynamic stabilization when used with careful attention to the patient’s unique anatomical characteristics.