Biventricular Circulatory Support Using 2 Axial Flow Catheters for Cardiogenic Shock Without the Need for Surgical Vascular Access

Biventricular failure in cardiogenic shock remains a major clinical problem. Use of percutaneously delivered, acute circulatory support devices for cardiogenic shock has grown exponentially due in large part to increasing global familiarity and clinical experience demonstrating hemodynamic efficacy of these devices.1 Until recently, percutaneous support options for biventricular failure have been limited to venoarterial extracorporeal membrane oxygenation or biventricular centrifugal flow pumps. We recently reported the first use of biventricular axial flow catheters with the Impella 5.0 and RP (Abiomed Inc) systems, which required surgical vascular access for the 5.0 implant.2 We now report the first patient with cardiogenic shock receiving biventricular support using the Impella CP and RP catheters (BiPella) without the need for surgical vascular access.A 30-year-old woman presented with hypotension and dyspnea after 1 week of a fever and lethargy. Within 24 hours of admission, hemodynamics demonstrated biventricular failure and an echocardiogram showed a left ventricular ejection fraction of 10% and severely dilated right ventricle (RV), despite treatment with an intra-aortic balloon pump, dobutamine, and norepinephrine (Table; Movie I in the …