Microaxial Left Ventricular Assist Device as Bridge to Transplantation in Postinfarction Left Ventricular Pseudoaneurysm.

BACKGROUND

Left ventricular (LV) pseudoaneurysm is a rare complication of myocardial infarction (MI) that may present with cardiogenic shock.

CASE SUMMARY: A 61-year-old man who had experienced MI 1 month prior presented with recurrent cardiogenic shock. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a large apical LV pseudoaneurysm compressing the right ventricle. Given prohibitive surgical risk, the patient was supported with prolonged Impella 5.5 therapy while awaiting heart transplantation. He remained hemodynamically stable throughout support and ultimately underwent successful heart transplantation.

DISCUSSION: Management of LV pseudoaneurysm typically involves surgical repair or conservative surveillance; however, literature describing prolonged mechanical circulatory support in this population remains sparse. This case demonstrates the feasibility of extended Impella support as a bridge to transplantation in a patient with post-MI LV pseudoaneurysm and cardiogenic shock. Impella-assisted LV unloading may mitigate aneurysmal wall stress, serving as a temporizing strategy in select high-risk patients.

TAKE-HOME MESSAGE: Prolonged Impella support may represent a viable bridge to heart transplantation in patients with LV pseudoaneurysm and cardiogenic shock who are unsuitable for surgical repair or durable left ventricular assist device therapy.