Escalation from Impella 5.5 to an ECPELLA configuration allowed hemodynamic stabilization and successful mitral valve replacement in a patient with cardiogenic shock and severe mitral regurgitation.
Case Report (n=1)
Does escalation to ECPELLA provide hemodynamic stabilization as a bridge to mitral valve surgery in a patient with cardiogenic shock secondary to acute mitral regurgitation and non-ischemic cardiomyopathy?
Escalation to ECPELLA may be necessary for hemodynamic stabilization in patients with acute valvular insufficiency and pre-existing cardiomyopathy who do not stabilize with Impella alone.
Severe mitral regurgitation (MR) is an important cause of acute heart failure and significant contributor to morbidity and mortality. Mechanical circulatory support (MCS) devices such as Impella are readily used to hemodynamically stabilize patients with cardiogenic shock (CS) secondary to this valvular pathology. Impella can also be combined with VA-ECMO to an "ECPELLA" configuration if further escalation of hemodynamic support is needed. We report a case of a 57-year-old female who presented with CS secondary to a perforated anterior mitral valve leaflet and non-ischemic cardiomyopathy that did not stabilize with initial choice of Impella 5.5. She required further escalation from axillary Impella 5.5 to the combined ECPELLA configuration, which allowed hemodynamic stabilization and ultimately a successful high-risk isolated mitral valve replacement. Despite adequate Impella flow, escalation to a combined MCS configuration, such as ECPELLA, may need to be considered upfront for acute valvular insufficiency in the setting of pre-existing cardiomyopathy.
Gregory et al. (Sat,) conducted a case report in Cardiogenic shock secondary to severe mitral regurgitation (n=1). Escalation from Impella 5.5 to ECPELLA was evaluated on Hemodynamic stabilization and successful mitral valve replacement. Escalation from Impella 5.5 to an ECPELLA configuration allowed hemodynamic stabilization and successful mitral valve replacement in a patient with cardiogenic shock and severe mitral regurgitation.