Abstract
BackgroundPercutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited.ObjectiveTo assess outcomes in women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry.Methods and ResultsA total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ± 7.34 years, eight women were Caucasian, and seven were African‐American. The occurrence of PPCM was post‐delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ± 6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno‐arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD).ConclusionMCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.
Highlights
| INTRODUCTIONPeripartum cardiomyopathy (PPCM) is a myocardial disease characterized by left ventricular (LV) systolic dysfunction
Peripartum cardiomyopathy (PPCM) is a myocardial disease characterized by left ventricular (LV) systolic dysfunction (LV ejection fraction< 45%) and heart failure, presenting typically in the later part of pregnancy or the first few months postpartum.[1]
We report on 15 women with peripartum cardiomyopathy (PPCM) supported with an Impella device from the global catheter-based ventricular assist device Registry
Summary
Peripartum cardiomyopathy (PPCM) is a myocardial disease characterized by left ventricular (LV) systolic dysfunction Age, increased rate of multifetal pregnancies, and increased recognition of the disease.[2] PPCM can be associated with severe complications including cardiogenic shock (CS), cardiac arrest, and death.[2,3] A recent meta-analysis of 46 studies from 13 countries on women with PPCM reported a global mortality rate of 9%.4. Recovery of LV function is frequently observed, the continued deterioration of cardiac function is reported in about 5%-20% and can lead to severe heart failure, cardiogenic shock, and mortality.[3] Early identification and hemodynamic stabilization is needed to increase the likelihood of myocardial recovery, in PPCM complicated by CS. This study, to our knowledge, is the largest reported series to date on the use of Impella devices in women with severe heart failure and CS due to PPCM
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