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Case Reports
. 2023 Apr 30;7(5):ytad214.
doi: 10.1093/ehjcr/ytad214. eCollection 2023 May.

A successful bridge to recovery with Impella 5.0 and subsequent hybrid cardiac resynchronization therapy in systemic right ventricle failure: a case report

Keiichiro Iwasaki  1 , Nobuhiro Nishii  2 , Satoshi Akagi  1 , Hiroshi Ito  1
Affiliations
Case Reports

A successful bridge to recovery with Impella 5.0 and subsequent hybrid cardiac resynchronization therapy in systemic right ventricle failure: a case report

Keiichiro Iwasaki et al. Eur Heart J Case Rep. .

Abstract

Background: Impella 5.0 is currently used as a temporary mechanical circulatory support device in cardiogenic shock (CS). However, Impella 5.0 implantation for the systemic right ventricle (sRV) has not been well documented.

Case summary: A 50-year-old man with atrial switch for dextro-transposition of the great arteries was transferred to our hospital for the treatment of embolic acute myocardial infarction of the left main trunk lesion with CS. To stabilize haemodynamics, we implanted Impella 5.0 via the left subclavian artery in the sRV. After optimal medical therapy initiation and gradual weaning of Impella 5.0, Impella 5.0 was successfully explanted. An electrocardiogram was obtained, which showed complete right branch block with a QRS duration of 172 ms. Acute invasive haemodynamic evaluation of cardiac resynchronization therapy (CRT) pacing showed that dP/dt increased from 497 to 605 mmHg/s (21.7% improvement), and hybrid cardiac resynchronization therapy defibrillator (CRTD) with a sRV epicardial lead was subsequently implanted. The patient was discharged without inotropic support.

Discussion: Coronary artery embolism is a rare but serious complication of dextro-transposition of the great arteries after atrial switch operations. Impella 5.0 implantation is a feasible bridge strategy for refractory CS due to sRV failure. Although CRT implantation in patients with sRV is controversial, an acute invasive haemodynamic evaluation can help assess its potential benefits.

Keywords: Cardiac resynchronization therapy; Case report; Impella; Mechanical circulatory support; Transposition of great arteries.

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Conflict of interest statement

Conflict of interest: Dr Nobuhiro Nishii is affiliated with a department endowed by Japan Medtronic Inc. The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Coronary angiography of the right (A) and left (B) coronary artery before coronary revascularisation and the left coronary artery after revascularisation (C).
Figure 2
Figure 2
The electrocardiogram with and without cardiac resynchronisation therapy (CRT) pacing (sinus rhythm).
Figure 3
Figure 3
Chest X-ray images of the patient during CRT pacing study (A) and CRTD implantation (B). The following devices were used: CRTD, Cobalt XT HF CRTD MRI; LA lead, CapsureFix Novus 5076–45; LV lead, Sprint Quattro Secure 6935M-55; and RV epicardial lead, 4968–35. CRTD, cardiac resynchronization therapy defibrillator; LA, left atrium; LSCV, left subclavian vein; LV, left ventricle; RFA, right femoral artery; RFV, right femoral vein; RV, right ventricle.
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