ArticleAnnals of thoracic surgery short reports2025
Mechanical Circulatory Support Strategies for Cardiogenic Shock Secondary to Peripartum Cardiomyopathy.
Article in Annals of thoracic surgery short reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Background: Peripartum cardiomyopathy (PPCM) is a severe complication of pregnancy hallmarked by nonischemic reduction in left ventricular ejection fraction to <45% late in gestation or shortly postpartum. This study evaluated outcomes among women who required mechanical circulatory support (MCS) for end-stage heart failure in the setting of PPCM. Methods: Thirty female patients 18-46 years of age underwent advanced heart failure surgical procedures for PPCM between 2012 and 2020. Primary heart transplant patients (n = 2) were excluded. PPCM patients with a new MCS requirement (n = 28) were classified by device type and escalations in device support. Results: Nineteen (68%) patients required temporary MCS: 12 (63%) intraaortic balloon pump, 9 (47%) venous-arterial extracorporeal membrane oxygenation, and 4 (21%) Impella heart pump (AbioMed Inc). Nine (32%) patients underwent left ventricular assist device implantation immediately after failure of medical therapy. Among temporary MCS recipients, 5 (26%) required escalations with additional modalities. Ten (53%) patients were bridged to durable left ventricular assist devices. Ejection fraction at MCS insertion was 14% ± 5% and progressed to 24% ± 16% postinsertion and 29% ± 17% 1 year after surgery. Complications included dialysis requirement (n = 5), right ventricular failure (n = 4), cardiac arrest (n = 3), and stroke (n = 2). Survival to discharge was 89% (n = 25). Twelve patients underwent transplant (43%), and 2 (7%) recovered native heart function. Conclusions: Severe PPCM can be effectively managed with MCS as a bridging strategy to either transplant or durable left ventricular assist device. Patients will often require multiple escalations in resource-intensive therapy, but outcomes are excellent with vigilant management.
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