Percutaneous extracorporeal ventricular assist device as a successful bridge strategy to durable left ventricular assist device in refractory cardiogenic shock: a case report.

INTRODUCTION

Cardiogenic shock (CS) is a life-threatening condition with high mortality. Temporary mechanical circulatory support (tMCS) is important for stabilizing patients with refractory CS, acting as a bridge to recovery, decision-making for durable left ventricular assist device (LVAD) implantation or transplantation. In China, commonly used devices like intra-aortic balloon pumps (IABP) and extracorporeal membrane oxygenation (ECMO) have limitations such as inadequate ventricular unloading and high complication rates, and advanced options like Impella, TandemHeart and CentriMag are not widely available. This report presents a successful bridge to durable LVAD therapy case using a minimally invasive extracorporeal VAD in a high-risk CS patient.

CASE SUMMARY: A 39-year-old male with refractory cardiogenic shock due to ischemic cardiomyopathy is reported. He was not a candidate for immediate durable LVAD implantation or transplantation because of unstable hemodynamics, severe pulmonary edema, and active infection. Considering his condition, a percutaneous extracorporeal VAD was inserted through the right axillary artery and jugular vein, creating a bypass from the left atrium → across the atrial septum → right atrium → superior vena cava → right jugular vein → centrifugal pump → axillary artery. The operation was carried out without any complications, and the patient quickly improved. After 215 h and 43 min of support, he successfully received durable LVAD implantation.

DISCUSSION: This case demonstrates the clinical value of a minimally invasive extracorporeal VAD as a bridge-to-bridge therapy for critical cardiogenic shock. The percutaneous approach effectively unloads the left ventricle while minimizing complications. It promotes early patient mobilization, simplifies postoperative care, and lowers treatment costs. This method is technically simple and controllable in most hospital environments, offering practical guidance for managing high-risk shock patients, especially in places where advanced surgical options are restricted.