One-week Impella CP support for papillary muscle rupture as a bridge to surgery: a case report

BACKGROUND: Papillary muscle rupture (PMR) is a catastrophic complication of acute myocardial infarction. However, the best timing and modality of circulatory support for surgery are unknown. CASE SUMMARY: A 75-year-old man presented to the emergency room in our hospital for worsening shortness of breath accompanied by chest pain. Transthoracic echocardiograph showed severe mitral regurgitation (MR) with a flail posterior mitral valve leaflet, and coronary angiography demonstrated distal right coronary artery occlusion. We diagnosed as cardiogenic shock due to subacute myocardial infarction and ischaemic PMR. An Impella CP (Abiomed, Danvers, MA, USA) was introduced to improve haemodynamics. Despite the grade of MR was still severe, the mean blood pressure and pulmonary artery pressure improved 4 h after an Impella CP support. At day 8, the patient underwent elective mitral valve replacement with single coronary artery bypass grafting. DISCUSSION: PMR is a rare but lethal complication of acute myocardial infarction. Expeditious surgical treatment offers the optimal chance of survival, but the post-operative mortality or morbidity is very high. Therefore, preoperative stabilization can be closely correlated with outcomes in these patients. It was reported that directly unloading the left ventricle by an Impella decreased wall stress, external work, and myocardial oxygen consumption. Therefore, an Impella can be the most suitable mechanical circulatory support for PMR. In conclusion, Impella CP alone can become one of the suitable bridges to surgery in the patients with PMR.