Mechanical circulatory support for cardiogenic shock during the peripartum period.

Abstract

Cardiomyopathies account for more than half of the cardiovascular disease during the peripartum period. In the extreme, patients may present with cardiogenic shock (CS) requiring mechanical circulatory support (MCS). The aim of this study was to report our experience with CS requiring MCS in the peripartum period. We present a single-center retrospective analysis of all CS cases involving MCS during the peripartum period that occurred between 2012 and 2023. Eleven cases were included. Median age was 33, median BMI was 30.4, and 73% underwent a caesarian-section for delivery. CS presentation occurred in 36.4% during pregnancy and in 63.6% after delivery. Most patients were in Society for Cardiovascular Angiography & Interventions (SCAI) Stage C shock and in 37% the suspected etiology was peripartum cardiomyopathy. MCS usage included intra-aortic balloon pump (4), Impella microaxial blood pump (2), veno-arterial extracorporeal membrane oxygenation (6), and temporary right ventricle assist devices (2), with some patients having multiple MCS devices. The rate of major complications was 36.4%. During a median follow-up of 4.5 years, 7 patients had sustained cardiac recovery (63.6%), 1 patient (9.1%) underwent cardiac transplantation, 2 patients (18.2%) received a durable LVAD, and 2 (18.2%) have died. MCS in severe CS cases during the peripartum period is rare and associated with favorable outcomes. High recovery rates suggest favoring first MCS/LVAD over transplant.