Mechanical circulatory support combined with bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy was associated with a 30-day survival of 100%.
Observational
Does early mechanical circulatory support combined with bromocriptine improve survival and myocardial recovery in patients with refractory cardiogenic shock complicating peripartum cardiomyopathy?
Early left ventricular unloading with mechanical circulatory support combined with bromocriptine therapy is associated with 100% 30-day survival and myocardial recovery in refractory cardiogenic shock complicating peripartum cardiomyopathy.
INTRODUCTION: Acute peripartum cardiomyopathy complicated by cardiogenic shock is a rare but life-threatening disease. A prolactin fragment is considered causal for the pathogenesis of peripartum cardiomyopathy. This analysis sought to investigate the role of early percutaneous mechanical circulatory support with micro-axial flow-pumps and/or veno-arterial extracorporeal membrane oxygenation in combination with the prolactin inhibitor bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy. METHODS AND RESULTS: =3) in the setting of biventricular failure. All patients were mechanically ventilated. In all cases mechanical circulatory support was combined with bromocriptine therapy and early administration of levosimendan. All patients survived the acute phase of refractory cardiogenic shock. Mechanical circulatory support using a micro-axial pump allowed to significantly reduce catecholamine dosage. Remarkably, early left ventricular support with micro-axial flow-pumps resulted in myocardial recovery whereas delayed Impella (mechanical circulatory support) implantation was associated with poor left ventricular recovery. CONCLUSION: Mechanical circulatory support in patients with refractory cardiogenic shock complicating peripartum cardiomyopathy was associated with a 30-day survival of 100% and a favourable outcome. Notably, early left ventricular unloading combined with bromocriptine therapy was associated with left ventricular recovery. Therefore, an immediate transfer to a tertiary hospital experienced in mechanical circulatory support in combination with bromocriptine treatment seems indispensable for successful treatment of peripartum cardiomyopathy complicated by cardiogenic shock.
Sieweke et al. (Thu,) conducted a observational in Refractory cardiogenic shock complicating peripartum cardiomyopathy. Mechanical circulatory support and bromocriptine was evaluated on 30-day survival. Mechanical circulatory support combined with bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy was associated with a 30-day survival of 100%.