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.