Abstract
Peripartum cardiomyopathy (PPCM) challenges different disciplines including gynecologists, cardiologists and cardiac surgeons. It is a severe cardiac failure occurring at the end of pregnancy or within the first months after delivery. Urgent intervention is necessary to stabilize hemodynamics with appropriate medication and mechanical assist support. Data of 4 patients with PPCM at a mean age of 28.2 years were analyzed retrospectively. Echocardiography was used to evaluate cardiac function. Despite varying courses of PPCM all women received left ventricular assist devices (LVAD) since their hemodynamics could not be stabilized by medical treatment. Mean gestational week at delivery was 31.5 ± 4.9. Left ventricular ejection fractions of all patients were severely impaired (17.8 ± 3.5 %) before LVAD implantations. After long-term mechanical support (282 and 417 days, respectively) 2 patients were successfully transplanted. Two other females could be weaned from LVAD therapy after 944 and 612 days, respectively. LVAD explanations were performed according to a standardized weaning protocol. Myocardial recovery was confirmed by regular echocardiography, spiroergometry and right heart catheterization. Mechanical assist device support is a surgical strategy either as bridge to transplantation or as bridge to recovery for patients with PPCM.
References
Garg J, Palaniswamy C, Lanier G. Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis and management. Cardiol Rev 2014 (epub ahead of print).
Fett JD. Peripartum cardiomyopathy: a puzzle closer to solution. World J Cardiol. 2014;6:87–99.
Birks EJ, George RS, Hedger M, Bahrami T, Wilton P, Bowles CT, Webb C, Bougard R, Amrani M, Yacoub MH, Dreyfus G, Khaghani A. Reversal of severe heart failure with a continuous-flow left ventricular assist device and pharmacological therapy a prospective study. Circulation. 2011;123:381–90.
Haghikia A, Podewski E, Libhaber E, Labidi S, Fischer D, Roentgen P, Tsikas D, Jordan J, Lichtinghagen R, von Kaisenberg CD, Struman I, Bovy N, Sliwa K, Bauersachs J, Hilfiker-Kleiner D. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol. 2013;108:366–78.
Zimmerman H, Bose R, Smith R, Copeland JG. Treatment of peripartum cardiomyopathy with mechanical assist devices and cardiac transplantation. Ann Thorac Surg. 2010;89:1211–7.
Su TW, Tseng YH, Wu TI, Lin PJ, Wu MY. Extracorporeal life support in adults with hemodynamic collapse from fulminant cardiomyopathies: the chance of bridging to recovery. ASAIO. 2014;60:664–9.
Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J. 2006;152:509–13.
Cooper LT, Mather PJ, Alexis JD, Pauly DF, Torre-Amione G, Wittstein IS, Dec GW, Zucker M, Narula J, Kip K, McNamara DM. Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and non-peripartum women. J Card Fail. 2012;18:28–33.
Frazier OH, Baldwin ACW, Demirozu ZT, Segura AM, Hernandez R, Taegtmeyer H, Mallidi H, Cohn WE. Ventricular reconditioning and pump explantation in patients supported by continuous-flow left ventricular assist devices. J Heart Lung Transplant 2014 (epub ahead of print).
Loyaga-Rendon RY, Pamboukian SV, Tallaj JA, Acharya D, Cantor R, Starling RC, Naftel D, Kirklin J. Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Circ Heart Fail. 2014;7:300–9.
Hilfiker-Kleiner D, Kaminski K, Podeswki E, Sliwa K. A cathepsin d-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. 2007;128:589–600.
Elkayam U. Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy. J Am Coll Cardiol. 2014;64:1629–36.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Scherer discloses that she was a consultant for Thoratec Corporation till 2014. All other authors report no conflicts of interest.
Rights and permissions
About this article
Cite this article
Lueck, S., Sindermann, J., Martens, S. et al. Mechanical circulatory support for patients with peripartum cardiomyopathy. J Artif Organs 19, 305–309 (2016). https://doi.org/10.1007/s10047-016-0891-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10047-016-0891-z