Triple bridge of mechanical circulatory support: A case report

• Published in: Journal of cardiothoracic and vascular anesthesia 2024-12, Vol.38 (12), p.46-46
• Main Authors: Deshmukh, Ketki, Mali, Shivaji, Dhake, Shyam, Shetty, Vijay, Mulay, Anvay, Malankar, Dhananjay
• Format: Article
• Language: English
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2024.09.079

Introduction Over the past 10 years, mechanical circulatory support (MCS) therapy has transformed care of patients with end stage heart failure. MCS devices are currently available for use and may have varying indications based on the clinical scenario. We are reporting rare case of a patient with dilated cardiomyopathy who required staged support of different MCS devices in Pre and Post Heart transplant phase. Case report A 12 year old male patient diagnosed case of dilated cardiomyopathy presented to our hospital with cardiogenic shock. A triple bridge of mechanical circulatory support was utilised to transition him to post heart transplantation phase. Initially, severe Left ventricular dysfunction was treated with LVAD as mechanical circulatory support for 12 days followed by Veno-Arterial extracorporeal membrane Oxygenator support in view of severe right ventricular dysfunction. Veno-Arterial ExtraCorporealMembraneOxygenator was continued for 7 days until the allocation of donor heart. Post heart transplantation patient experienced severe right ventricular dysfunction and was supported with right ventricular assist device for 5 days as the third stage of mechanical circulatory support. Patient was discharged home on post-operative day 56 with stable haemodynamics and intact neurological status. Discussion In management of patients with end-stage heart failure, MCS has played a pivotal role. Our patient had a successful outcome with the use of triple bridge of MCS to facilitate management of severe heart failure in various stages. It is uncommon for more than two consecutive MCS devices to be used in the same patient. We report a case of a patient who required MCS devices in both pre and post-transplant phase. Combination of MCS devices used in a sequential manner can be lifesaving depending on the clinical situation. In our patient LVAD and ECMO were successful in bridging our patient to Heart transplant. RVAD support post transplantation was lifesaving.