Temporary Left Ventricular Assist Device for Peripartum Cardiogenic Shock as a Bridge to Cesarean Delivery.

BACKGROUND: Pregnancies associated with pre-existing heart disease are at increased risk for clinical decompensation in the antenatal and postpartum periods given the altered physiologic and hemodynamic demands on the circulatory system that occur during pregnancy. CASE SUMMARY: We describe 2 patients with pre-existing heart failure with reduced ejection fraction (HFrEF) who developed cardiogenic shock during the third trimester and required multidisciplinary clinical evaluation and use of temporary percutaneous left ventricular assist devices (pLVADs) as a support strategy through cesarean delivery. DISCUSSION: Temporary pLVADs are useful in cardiogenic shock during high-risk peripartum periods to manage severe left ventricular noncompliance, hemodynamic changes associated with delivery, operative fluid shifts, and postpartum autotransfusion. TAKE-HOME MESSAGES: Temporary pLVADs serve as an effective bridge to cesarean delivery. Peridelivery cardiovascular risk stratification, optimal employment of temporary pLVADs, and balancing anticoagulation required for temporary LVAD with perioperative bleeding risks are nuanced clinical decisions that require multidisciplinary planning.

Duke Scholars

Author Vishal Narasinga Rao Medicine, Cardiology