Background: Pregnancies associated with preexisting heart disease are at increased risk for clinical decompensation in the antenatal and postpartum periods due to the altered physiologic and hemodynamic demands on the circulatory system that occur during pregnancy.
Case Summary: We present two patient cases with pre-existing heart failure with reduced ejection fraction (HFrEF) who developed cardiogenic shock (CS) during the third trimester requiring multidisciplinary clinical evaluation and use of temporary percutaneous left ventricular assist devices (pLVADs) as a support strategy through cesarean delivery.
Discussion: Temporary pLVADs are useful in CS during high-risk peripartum periods to manage severe left ventricular noncompliance, hemodynamic changes associated with delivery, operative fluid shifts, and postpartum autotransfusion.
Take-Home Messages: Temporary pLVADs serve as an effective bridge to cesarean delivery. Peri-delivery cardiovascular risk stratification, optimal employment of temporary pLVADs, and balancing anticoagulation required for temporary LVAD with peri-operative bleeding risks are nuanced clinical decisions that require multidisciplinary planning.
JACC Case Reports Interim Editors-in-Chief
Gilbert H. L. Tang, MD, MSc, MBA
CME Editor
Kenneth A. Ellenbogen, MD
Author
Megan Pelter, MD
Important Dates
Date of Release: April 1, 2026
Term of Approval/Date of CME/MOC Expiration: March 31, 2027