Mechanical unloading by miniature axial flow pumps in late cardiac allograft failure due to acute rejection

Abstract

Allograft failure secondary to rejection commonly requires a multimodal treatment, ultimately including mechanical circulatory support. A few case reports have demonstrated the use of Impella-devices due to its assumed favorable safety profile in this fragile cohort. However, this treatment option does not play a role in choice of anti-rejective therapy in clinical routine up to date. We summarize our institutional experiences and literature mini-review on Impella-based treatment strategies in allograft rejection after heart transplantation. In all seven cases, three from our institution and four reported in the literature, Impella-based therapies led to hemodynamic stabilization in allograft failure secondary to rejection. Adverse events included hemolysis, non-fatal bleeding and in one patient a relevant aortic valve insufficiency occurred. All patients showed an improvement of allograft function. Two patients died in context of severe immunosuppression or late secondary organ failure. Based on the limited available data, we propose that Impella-mediated mechanical unloading represents a valuable option for hemodynamic stabilization in severe allograft failure due to rejection, enabling an initiation of causal therapy and thereby potentially representing an opportunity to prevent mortality. Furthermore, we hypothesize it might add to the traditional therapeutic approaches by facilitating recovery by decompressing the myocardium in allograft rejection.

Percutaneous mitral valve repair assisted by a catheter‐based circulatory support device in a heart transplant patient

“…Cardiogenic shock (CS) ranks among the leading causes of in‐hospital mortality in developed countries, requiring complex, and rapid therapy management. Temporary mechanical circulatory support (tempMCS) 1 has been established as an effective therapy in CS patients. In the case of isolated left ventricular dysfunction, microaxial catheter‐based left ventricular assist devices (LVADs) are frequently used 2 .…”