Total Artificial Heart as a Bridge to Transplantation in Cardiogenic Shock Due to Ruptured Cardiac Pseudoaneurysm.

BACKGROUND

Cardiogenic shock (CS) due to contained cardiac rupture is a life-threatening condition that severely limits access to advanced heart failure therapies.

CASE SUMMARY: A 53-year-old man with dilated cardiomyopathy and recent mechanical aortic valve replacement for infective endocarditis presented in CS. Imaging identified a large apical pseudoaneurysm, consistent with contained apical rupture. The multidisciplinary shock team opted for implantation of a new-generation total artificial heart as a bridge to transplantation. Postoperative recovery included a period of transient renal replacement therapy. The patient was discharged home on day 53 and remained stable at 6 months postoperatively.

DISCUSSION: Hemodynamic instability, anatomical complexity, rupture risk, and the presence of a mechanical valve rendered conventional options-surgical repair, temporary and durable mechanical support, and transplantation-highly risky.

TAKE-HOME MESSAGE: In carefully selected CS patients with nonrepairable structural damage, the new-generation total artificial heart offers a viable and life-saving bridge to transplantation.