Introduction
Post-infarct papillary muscle rupture (PMR) is a rare critical complication that occurs in 1–3% of patients after acute myocardial infarction (AMI). 1PMR leads to cardiogenic shock (CGS) and pulmonary edema (PLE) due to severe mitral regurgitation (MR).1-3 A high operative mortality rate of 13–40% associated with mitral valve surgery for PMR has been reported.2-5
Appropriate preoperative mechanical circulatory support (MCS), such as intra-aortic balloon pumping (IABP) or venoarterial extracorporeal membrane oxygenation (V/AECMO), may improve surgical outcomes in patients with PMR. 4, 5 Successful management using Impella® (Abiomed Inc., Danvers, MA) as a temporary percutaneous ventricular assist device for post-AMI MR, including PMR, has been also reported. 6, 7
The combination of Impella and V/AECMO (ECPELLA) is a useful MCS strategy in cases of severe hypoxia with CGS. We aggressively initiated ECPELLA as a bridge to surgery for CGS due to PMR. Herein, we present our surgical and MCS management during mitral valve replacement (MVR) in which we applied ECPELLA for CGS due to PMR.