Percutaneous Circulatory Support for Biventricular Failure

Biventricular (BiV) failure is associated with a high rate of in-hospital mortality despite advances in therapeutic interventions.1 Multiorgan system dysfunction (MOSD) is a frequent complication of BiV shock and often prohibits surgical ventricular assist device (VAD) placement. Patients with refractory cardiogenic shock may benefit from temporary BiV support to allow for organ recovery and to assess right ventricular (RV) function better with mechanical decompression of the left ventricle (LV).2 We report 2 cases of percutaneous BiV circulatory support with refractory cardiogenic shock.A 67-year-old man with a nonischemic dilated cardiomyopathy presented with acutely decompensated heart failure. An echocardiogram showed an LV ejection fraction of 10%, moderately depressed RV function, and moderate tricuspid regurgitation (Movie I in the online-only Data Supplement). Right heart catheterization demonstrated a severely reduced cardiac output, elevated BiV filling pressures, and pulmonary hypertension (Table). The patient eventually developed MOSD refractory to dual inotropes, vasopressors, and a Mega (50 mL) intra-aortic balloon pump (Maquet, Inc). Because of MOSD, the patient was deemed a poor candidate for surgical VAD implantation. An Impella 5.0 axial-flow device was then deployed via the right axillary …