Temporary Left Ventricular Assist Device for Peripartum Cardiogenic Shock as a Bridge to Cesarean Delivery
Abstract
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.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.