Abstract
INTRODUCTION: Intra-aortic balloon pumping (IABP), Impella, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are common percutaneous devices used to manage hemodynamic instability in patients with cardiogenic shock. These devices play a critical role in providing circulatory support. However, they may fail to achieve sufficient left ventricular unloading in patients with aortic valve regurgitation (AR), potentially complicating treatment strategies. In such challenging cases, an extracorporeal left ventricular assist device (LVAD) may serve as an effective alternative solution.
CASE PRESENTATION: A 61-year-old man presented with heart failure and cardiogenic shock, further complicated by AR. Despite intensive inotropic therapy, his condition deteriorated, leading to significant hepatic and renal dysfunction. Echocardiography revealed left ventricular dysfunction with an ejection fraction of 23.5%, as well as moderate aortic, mitral, and tricuspid valve regurgitation. Initial management with VA-ECMO proved inadequate, necessitating the implantation of an extracorporeal LVAD. This intervention resulted in marked improvements in hemodynamics and multi-organ function. Subsequently, the patient underwent successful surgical procedures, including aortic valve replacement, mitral and tricuspid annuloplasty, and pulmonary vein isolation. He was discharged on day 51.
CONCLUSIONS: This case highlights the challenges in managing cardiogenic shock with AR, where conventional devices like IABP, Impella, and VA-ECMO may exacerbate the condition. The use of an extracorporeal LVAD provided effective left ventricular unloading, enabling successful preoperative optimization and surgery. This case supports the utility of LVAD as a bridge to surgery in patients with cardiogenic shock and AR, suggesting a need for further research into optimal management strategies in such complex cases.
