Diagnosis and treatment strategies for cardiogenic shock in Takotsubo syndrome with a temporary left ventricular assist device—A single-center study

Background: Takotsubo syndrome (TTS) is a reversible form of acute heart failure characterized by apical ballooning, which may lead to cardiogenic shock (CS). When CS occurs, mechanical circulatory support (MCS) may be used to bridge patients until cardiac recovery. However, the role, optimal timing, and choice of MCS remain unclear. Methods: On February 22, 2024, a search of the clinic's electronic database was performed for patients diagnosed with TTS. The search yielded 47 patients, with 9 patients receiving MCS. Individual patient data concerning these 9 cases were extracted and analyzed. Results: Of 9 TTS patients with MCS, 5 were supported by an Impella system, with the remaining 4 patients receiving a combination of Impella and extracorporeal membrane oxygenation. Left ventricular ejection fraction measured at admission ranged from 10% to 36%, with 4 patients showing full recovery of left ventricular ejection function. Three patients died in the hospital and 1 patient remains on long-term support with a HeartMate 3 left ventricular assist device. Conclusions: This retrospective single-center study on the use of MCS in TTS management supports results from previous studies reporting on the benefit of Impella therapy. Our experience shows that Impella support provides stabilization of CS and unloading of the left ventricle, allowing full recovery of left ventricular function and reversing TTS findings. For patients who do not adequately respond to Impella support alone, escalation to a combination of Impella and extracorporeal membrane oxygenation strategy is feasible to further improve cardiac output, while protecting the left ventricle from the increased afterload