Although veno-arterial
extracorporeal membrane oxygenation (VA-ECMO) has been used to aid myocardial recovery in patients with postcardiotomy
cardiogenic shock (PCCS), it has been associated with adverse effects. The combined use of VA-ECMO and Impella (ECPELLA) for PCCS, however, has been reported to be efficacious with few reports of thromboembolic events. We present a case of aortic
thrombosis with visceral malperfusion during ECPELLA management for PCCS. We performed the Bentall procedure, mitral valve repair, tricuspid annuloplasty, and
coronary artery bypass graft on a 73-year-old man admitted with
congestive heart failure caused by
annuloaortic ectasia, along with severe aortic and
mitral regurgitation. VA-ECMO and Impella were required, since the
cardiopulmonary bypass weaning was difficult. Impella was removed on postoperative day 4. On postoperative days 5 and 6, laboratory data showed worsening renal dysfunction,
lactate levels, and
acidosis. Contrast-enhanced computed tomography showed
thrombosis in the celiac and superior mesenteric arteries. Aortic
thrombectomy was performed.
Hyperkalemia, caused by a
reperfusion injury, resulted in
ventricular fibrillation. Continuous
hemodiafiltration improved the
hyperkalemia. However, irreversible
acidosis progressed, and the VA-ECMO flow rate could not be sustained. On postoperative day 7, the patient died. Perioperative use of Impella for PCCS may be effective in improving postoperative cardiac function. When sudden organ failure is observed after surgery, it is necessary to not only keep the exacerbation of
cardiogenic shock in mind, but also the possibility of
thrombosis.