Short-term mechanical circulatory support for cardiogenic shock in severe peripartum cardiomyopathy: La Pitié-Salpêtrière experience

OBJECTIVES: Mechanical circulatory support (MCS) is a valuable option in the setting of cardiogenic shock (CS), although MCS use in severe forms of peripartum cardiomyopathy (PPCM) is underreported. We aimed to investigate maternal outcomes under MCS for refractory CS complicating PPCM. METHODS: We retrospectively reviewed 10 consecutive patients (2010-2015) meeting diagnosis criteria of PPCM that were managed with peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) for severe CS. RESULTS: Median age was 29 years (range 20-36), and median left ventricular (LV) ejection fraction was 10% (range 5-30). All patients received femoro-femoral cannulation. All patients were implanted after delivery. Central rescue cannulation was considered in 5 patients in the setting of peripheral ECMO-related complications. Median peripheral support duration was 4 days (range 2-25), median central support duration was 51 days (range 9-180). Five patients died under central support. Three patients were successfully explanted after LV recovery, and 2 were successfully transplanted. CONCLUSIONS: Peripheral VA-ECMO, and prompt conversion to central rescue cannulation when necessary have to be considered in the management of severe cases of PPCM. Nevertheless, refractory CS in this specific population remains a life-threatening condition despite aggressive management.