Acute Effects of Left Ventricular Support With Impella 5.5 on Biventricular Hemodynamics

Abstract

Identification of patients with cardiogenic shock and right ventricle (RV) dysfunction who may require biventricular rather than isolated left ventricular (LV) support remains challenging.In this setting, rigorous hemodynamic evaluation of biventricular contractility and load during initiation of LV support guides therapy.We now report a novel approach to assess biventricular pressure-volume loops in a patient receiving Impella 5.5 support for heart failure and shock. Case reportA 50-year-old man with non-ischemic cardiomyopathy requiring home milrinone, severe mitral regurgitation, chronic kidney disease and non-insulin dependent diabetes mellitus presented with acute decompensated heart failure and cardiogenic shock.Despite increasing inotropic and vasopressor therapy, he continued to deteriorate and was transferred to our institution for consideration of mechanical circulatory support as a bridge to possible heartkidney transplant.