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Acute and critically ill peripartum cardiomyopathy and 'bridge to' therapeutic options : a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices

Sofie Gevaert (UGent) , Yves Van Belleghem (UGent) , Stefaan Bouchez (UGent) , Ingrid Herck (UGent) , Filip De Somer (UGent) , Yasmina De Block (UGent) , Fiona Tromp (UGent) , Els Vandecasteele (UGent) , FLOOR MARTENS (UGent) and Michel De Pauw (UGent)
(2011) CRITICAL CARE. 15(2).
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Abstract
Introduction: Peripartum cardiomyopathy (PPCM) patients refractory to medical therapy and intra-aortic balloon pump (IABP) counterpulsation or in whom weaning from these therapies is impossible, are candidates for a left ventricular assist device (LVAD) as a bridge to recovery or transplant. Continuous-flow LVADs are smaller, have a better long-term durability and are associated with better outcomes. Extra corporeal membrane oxygenation (ECMO) can be used as a temporary support in patients with refractory cardiogenic shock. The aim of this study was to evaluate the efficacy and safety of mechanical support in acute and critically ill PPCM patients. Methods: This was a retrospective search of the patient database of the Ghent University hospital (2000 to 2010). Results: Six PPCM-patients were treated with mechanical support. Three patients presented in the postpartum period and three patients at the end of pregnancy. All were treated with IABP, the duration of IABP support ranged from 1 to 13 days. An ECMO was inserted in one patient who presented with cardiogenic shock, multiple organ dysfunction syndrome and a stillborn baby. Two patients showed partial recovery and could be weaned off the IABP. Four patients were implanted with a continuous-flow LVAD (HeartMate II(R), Thoratec Inc.), including the ECMO-patient. Three LVAD patients were successfully transplanted 78, 126 and 360 days after LVAD implant; one patient is still on the transplant waiting list. We observed one peripheral thrombotic complication due to IABP and five early bleeding complications in three LVAD patients. One patient died suddenly two years after transplantation. Conclusions: In PPCM with refractory heart failure IABP was safe and efficient as a bridge to recovery or as a bridge to LVAD. ECMO provided temporary support as a bridge to LVAD, while the newer continuous-flow LVADs offered a safe bridge to transplant.
Keywords
DIAGNOSIS, CARDIAC TRANSPLANTATION, PREGNANCY, PATIENT, HEART-TRANSPLANTATION

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Chicago
Gevaert, Sofie, Yves Van Belleghem, Stefaan Bouchez, Ingrid Herck, Filip De Somer, Yasmina De Block, Fiona Tromp, Els Vandecasteele, FLOOR MARTENS, and Michel De Pauw. 2011. “Acute and Critically Ill Peripartum Cardiomyopathy and ‘Bridge to’ Therapeutic Options : a Single Center Experience with Intra-aortic Balloon Pump, Extra Corporeal Membrane Oxygenation and Continuous-flow Left Ventricular Assist Devices.” Critical Care 15 (2).
APA
Gevaert, Sofie, Van Belleghem, Y., Bouchez, S., Herck, I., De Somer, F., De Block, Y., Tromp, F., et al. (2011). Acute and critically ill peripartum cardiomyopathy and “bridge to” therapeutic options : a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices. CRITICAL CARE, 15(2).
Vancouver
1.
Gevaert S, Van Belleghem Y, Bouchez S, Herck I, De Somer F, De Block Y, et al. Acute and critically ill peripartum cardiomyopathy and “bridge to” therapeutic options : a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices. CRITICAL CARE. 2011;15(2).
MLA
Gevaert, Sofie, Yves Van Belleghem, Stefaan Bouchez, et al. “Acute and Critically Ill Peripartum Cardiomyopathy and ‘Bridge to’ Therapeutic Options : a Single Center Experience with Intra-aortic Balloon Pump, Extra Corporeal Membrane Oxygenation and Continuous-flow Left Ventricular Assist Devices.” CRITICAL CARE 15.2 (2011): n. pag. Print.
@article{1900517,
  abstract     = {Introduction: Peripartum cardiomyopathy (PPCM) patients refractory to medical therapy and intra-aortic balloon pump (IABP) counterpulsation or in whom weaning from these therapies is impossible, are candidates for a left ventricular assist device (LVAD) as a bridge to recovery or transplant. Continuous-flow LVADs are smaller, have a better long-term durability and are associated with better outcomes. Extra corporeal membrane oxygenation (ECMO) can be used as a temporary support in patients with refractory cardiogenic shock. The aim of this study was to evaluate the efficacy and safety of mechanical support in acute and critically ill PPCM patients. 
Methods: This was a retrospective search of the patient database of the Ghent University hospital (2000 to 2010). 
Results: Six PPCM-patients were treated with mechanical support. Three patients presented in the postpartum period and three patients at the end of pregnancy. All were treated with IABP, the duration of IABP support ranged from 1 to 13 days. An ECMO was inserted in one patient who presented with cardiogenic shock, multiple organ dysfunction syndrome and a stillborn baby. Two patients showed partial recovery and could be weaned off the IABP. Four patients were implanted with a continuous-flow LVAD (HeartMate II(R), Thoratec Inc.), including the ECMO-patient. Three LVAD patients were successfully transplanted 78, 126 and 360 days after LVAD implant; one patient is still on the transplant waiting list. We observed one peripheral thrombotic complication due to IABP and five early bleeding complications in three LVAD patients. One patient died suddenly two years after transplantation. 
Conclusions: In PPCM with refractory heart failure IABP was safe and efficient as a bridge to recovery or as a bridge to LVAD. ECMO provided temporary support as a bridge to LVAD, while the newer continuous-flow LVADs offered a safe bridge to transplant.},
  articleno    = {R93},
  author       = {Gevaert, Sofie and Van Belleghem, Yves and Bouchez, Stefaan and Herck, Ingrid and De Somer, Filip and De Block, Yasmina and Tromp, Fiona and Vandecasteele, Els and MARTENS, FLOOR and De Pauw, Michel},
  issn         = {1466-609X},
  journal      = {CRITICAL CARE},
  keywords     = {DIAGNOSIS,CARDIAC TRANSPLANTATION,PREGNANCY,PATIENT,HEART-TRANSPLANTATION},
  language     = {eng},
  number       = {2},
  pages        = {7},
  title        = {Acute and critically ill peripartum cardiomyopathy and 'bridge to' therapeutic options : a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices},
  url          = {http://dx.doi.org/10.1186/cc10098},
  volume       = {15},
  year         = {2011},
}

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