Key result
Impella 5.0 plus hybrid CRTD stabilizes hemodynamics and improves dP/dt ~22% in systemic RV failure.
Why the study?
Impella 5.0 implantation for temporary mechanical circulatory support in systemic right ventricle failure has not been well documented.
Case Report (n=1)
No
Impella 5.0 implantation in the systemic right ventricle is a feasible bridge-to-recovery strategy for refractory cardiogenic shock in patients with dextro-transposition of the great arteries after atrial switch operations.
May support bridge-to-recovery in refractory systemic RV shock; hypothesis-generating and requires prospective validation before practice change.
Background: Impella 5.0 is currently used as a temporary mechanical circulatory support device in cardiogenic shock (CS). However, Impella 5.0 implantation for the systemic right ventricle (sRV) has not been well documented. Case summary: A 50-year-old man with atrial switch for dextro-transposition of the great arteries was transferred to our hospital for the treatment of embolic acute myocardial infarction of the left main trunk lesion with CS. To stabilize haemodynamics, we implanted Impella 5.0 via the left subclavian artery in the sRV. After optimal medical therapy initiation and gradual weaning of Impella 5.0, Impella 5.0 was successfully explanted. An electrocardiogram was obtained, which showed complete right branch block with a QRS duration of 172 ms. Acute invasive haemodynamic evaluation of cardiac resynchronization therapy (CRT) pacing showed that dP/dt increased from 497 to 605 mmHg/s (21.7% improvement), and hybrid cardiac resynchronization therapy defibrillator (CRTD) with a sRV epicardial lead was subsequently implanted. The patient was discharged without inotropic support. Discussion: Coronary artery embolism is a rare but serious complication of dextro-transposition of the great arteries after atrial switch operations. Impella 5.0 implantation is a feasible bridge strategy for refractory CS due to sRV failure. Although CRT implantation in patients with sRV is controversial, an acute invasive haemodynamic evaluation can help assess its potential benefits.
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Iwasaki et al. (2023) conducted a case report in Systemic right ventricle failure with cardiogenic shock (n=1). Impella 5.0 and hybrid cardiac resynchronization therapy was evaluated on Haemodynamic stabilization and recovery. Impella 5.0 implantation followed by hybrid cardiac resynchronization therapy successfully stabilized haemodynamics and improved dP/dt by 21.7% in a patient with systemic right ventricle failure.
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