56: ECPELLA as a bridge to ventricular assist device

Background: ECPELLA is a novel temporary mechanical circulatory support (tMCS) configuration combining veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with a micro-axial pump device (Impella). It provides biventricular support and left ventricular unloading in severe cardiogenic shock. We report a case illustrating ECPELLA as a bridge to durable ventricular assist device (VAD). Case Description: A 45-year-old man with no comorbidities presented to the emergency department with fever, cough, chest pain, and acute breathlessness. On arrival, he had wide complex tachycardia, hypotension requiring vasopressors, and echocardiography showed left ventricular ejection fraction (LVEF) of 30%. He tested positive for Influenza A and was diagnosed with myocarditis, presenting with SCAI D cardiogenic shock. Progressive shock led to intra-aortic balloon pump (IABP) insertion and escalation to VA-ECMO after a brief cardiac arrest. Coronary angiography was normal. LVEF deteriorated to 10% with global hypokinesia and moderate right ventricular dysfunction. On day 2, due to a non-opening aortic valve and LV dilation, the IABP was removed and an Impella device inserted, establishing ECPELLA support. Renal replacement therapy was initiated for acute kidney injury. Vasopressor requirements decreased, lactate normalized, transaminitis improved, and neurological status remained intact. Despite 8 days of ECPELLA support, the patient developed idioventricular rhythm and cardiac function did not recover. He was considered for durable VAD and transferred to a transplant center, where ECPELLA was transitioned to a BiVAD. The patient is currently recuperating post-tracheostomy. Conclusion: This case highlights ECPELLA as a feasible bridge to durable VAD in severe cardiogenic shock due to viral myocarditis. ECPELLA provides hemodynamic stabilization, LV unloading, and end-organ support, enabling safe transition to long-term mechanical circulatory support when native cardiac recovery is unlikely.