Temporary Left Ventricular Assist Device for Peripartum Cardiogenic Shock as a Bridge to Cesarean Delivery (JACC Case Reports April 2026)-Article: Temporary Left Ventricular Assist Device for Peripartum Cardiogenic Shock as a Bridge to Cesarean Delivery

Pdf Summary

This case series reports two pregnant patients with pre-existing heart failure with reduced ejection fraction (HFrEF) who developed third-trimester cardiogenic shock and were managed with temporary percutaneous left ventricular assist devices (pLVADs) as a bridge to cesarean delivery.<br /><br />Both patients had complex cardiac disease and multiple comorbidities. In each case, multidisciplinary planning involved maternal-fetal medicine, advanced heart failure cardiology, interventional cardiology, anesthesia, and surgery. The pLVAD was placed before delivery to stabilize hemodynamics, support end-organ perfusion, and reduce the risk of collapse during anesthesia, surgery, and postpartum fluid shifts.<br /><br />Case 1 involved a 33-year-old with familial nonischemic cardiomyopathy and severe biventricular dysfunction. She developed worsening heart failure and then cardiogenic shock at 32 weeks’ gestation, with recurrent fetal decelerations. A femoral pLVAD was inserted, followed by cesarean delivery and bilateral salpingectomy. She initially improved and the device was removed on postoperative day 3, but she later decompensated, required re-escalation of support, and underwent heart transplantation. The infant survived and was discharged after NICU care.<br /><br />Case 2 involved a 43-year-old with nonischemic cardiomyopathy after COVID-19, severe obesity, chronic kidney disease, and superimposed pre-eclampsia. She developed acute-on-chronic heart failure and cardiogenic shock at 31+5 weeks. A pLVAD was placed, later exchanged due to suspected thrombosis, and cesarean delivery was performed the next day under general anesthesia. Postpartum anticoagulation was restarted carefully; she had mild bleeding and a groin hematoma but recovered without major complications. The infant was also discharged after NICU care.<br /><br />The authors conclude that temporary pLVADs can be an effective bridge to cesarean delivery in peripartum cardiogenic shock, but anticoagulation and bleeding risks require careful individualized, multidisciplinary management.

Meta Tag

Concept Pregnancy

Concept Heart Failure with Reduced Ejection Fraction

Concept Cardiogenic Shock

Concept Temporary Percutaneous Left Ventricular Assist Device

Concept Peripartum Period

Keywords

pregnancy

heart failure with reduced ejection fraction

cardiogenic shock

temporary percutaneous left ventricular assist device

pLVAD

cesarean delivery

peripartum cardiomyopathy

multidisciplinary management

anticoagulation

postpartum complications

Pregnancy

Heart Failure with Reduced Ejection Fraction

Cardiogenic Shock

Temporary Percutaneous Left Ventricular Assist Device

Peripartum Period