Circulatory support with right ventricular assist device and intra-aortic balloon counterpulsation in patient with right ventricle failure after pulmonary embolectomy

Abstract

Severe pulmonary embolism may lead to acute right ventricular failure despite immediate surgical embolectomy, which is regarded as the treatment of choice after recent CABG surgery. We report a case of a patient with massive pulmonary thromboembolism which resulted in acute right ventricular failure following early surgical embolectomy. Pulmonary embolism developed two days after an elective off-pump CABG surgery. We observed severe circulatory collapse which resulted in cardiac arrest and proved refractory to pharmacological treatment after immediate cardiopulmonary resuscitation. Intra-aortic balloon pumping was used in an attempt to improve hemodynamic performance during surgical skin preparation. After the completion of the embolectomy and failure to wean the patient from CPB, upon clinical signs of low cardiac output and akinetic right ventricle, the decision was made to support its function with a centrifugal pump. The substantial improvement of the right ventricular function observed in the next 24 h allowed weaning the patient from right ventricle support. In spite of hemodynamic recovery, the patient remained in a coma on discharge from the cardiac-surgical ICU after 18 days, and died 10 days later from systemic infection.

Percutaneous Right Ventricular Assist Device for Massive Pulmonary Embolism

“…Sparse case reports suggest managing refractory RV failure from PE with peripheral extracorporeal membrane oxygenation, [1][2][3] whereas another case report describes the use of a surgically placed right ventricular assist devices (RVAD) after surgical embolectomy. 4 Here we describe a patient with persistent cardiogenic shock and RV failure after a massive PE despite treatment with systemic thrombolysis, who was rescued with the percutaneous placement of an RVAD followed by additional catheter-directed thrombolysis.A 48-year-old man with recent abdominal surgeries, including an ileocolostomy 1 month prior to presentation, had a witnessed syncopal event at home. The patient was found in the field to be unresponsive, with a systolic blood pressure of 70 mm Hg.…”