Axillary microaxial flow pump support for stepwise source control and bridge to durable left ventricular assist device therapy in cardiac device-related infective endocarditis.
Yohei Tamura, Shiro Nakahara, Masahito Saito et al.
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Case in brief
A 53-year-old man with long-standing dilated cardiomyopathy presented with cardiac resynchronization therapy-defibrillator infection, methicillin-sensitive Staphylococcus aureus bacteremia, respiratory failure, acute kidney injury, and mixed septic-cardiogenic shock. Echocardiography showed severe left ventricular dilatation and an ejection fraction of 10%. Given the perceived high risk of extracting a 17-year-old lead immediately, an Impella 5.5 was placed via the right subclavian artery and pocket drainage performed. After stabilization, all leads were extracted under Impella support without sustained systemic hemodynamic collapse. With intravenous antibiotics, cultures became negative and renal function recovered sufficiently to stop continuous hemodiafiltration. He was transferred to an advanced heart failure center and subsequently underwent durable left ventricular assist device implantation.
What made this case unusual
Axillary Impella 5.5 support enabled staged source control and extraction of a long-standing defibrillator lead in a patient with severe ventricular dysfunction and mixed shock, followed by recovery sufficient to bridge to durable LVAD implantation.
Diagnostic / clinical pearl
In device-related endocarditis with severe ventricular dysfunction and shock, staged source control and lead extraction under temporary mechanical circulatory support may be feasible in carefully selected patients.