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Impella 5.0 support before, during, and after surgical ventriculoplasty following acute myocardial infarction in the COVID-19 era: a case report.
Briani, Martina; Torracca, Lucia; Crescenzi, Giuseppe; Barbone, Alessandro.
  • Briani M; Department of Clinical and Interventional Cardiology, Humanitas Clinical and Research Centre, IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy.
  • Torracca L; Department of Cardiothoracic Surgery, Humanitas Clinical and Research Centre, IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy.
  • Crescenzi G; Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Hospital, IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy.
  • Barbone A; Department of Cardiothoracic Surgery, Humanitas Clinical and Research Centre, IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy.
Eur Heart J Case Rep ; 5(3): ytab037, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1223355
ABSTRACT

BACKGROUND:

Left ventricular (LV) aneurysms complicate anterior myocardial infarctions (MIs) in 8-15% of cases. In case of associated LV dysfunction, rapidly evolving heart failure may follow, and urgent surgery becomes life-saving. CASE

SUMMARY:

Following an acute anterior MI treated by percutaneous coronary intervention, which resulted in apical hypokinesis, depressed LV function, and moderate mitral regurgitation, a 70-year-old male patient kept in contact with our cardiology department through phone calls. Over 6 weeks, the patient's conditions worsened. For fear of contracting COVID-19, he refused to attend to the Emergency Room. Conditions did not improve despite medical therapy adjustments, and he was admitted to hospital following a syncope. Computed tomography scan revealed pneumonia, and he was placed in a 'grey' ward while waiting for nose-swab results for COVID-19. A rapid escalation of treatment was necessary as conditions did not improve with low-dose inotropes, and he required invasive ventilation. An Impella 5.0 was implanted as support prior to surgery, was maintained during the procedure and as a means of weaning off extracorporeal circulation. Surgery was successful and Impella 5.0 was removed on postoperative Day 5.

DISCUSSION:

To date, Impella use in cardiothoracic surgery has been described in case of ventricular septal rupture or as a bridge to permanent LV assist device. In our case, Impella 5.0 was implanted, used as a bridge to surgery, and as postoperative support in a patient with evolving cardiogenic shock due to LV aneurysm and depressed LV ejection fraction following acute MI, in the difficult setting of the COVID-19 pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Experimental Studies Language: English Journal: Eur Heart J Case Rep Year: 2021 Document Type: Article Affiliation country: Ehjcr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Experimental Studies Language: English Journal: Eur Heart J Case Rep Year: 2021 Document Type: Article Affiliation country: Ehjcr