# Unexpected Percutaneous Ventricular Assist Device Failure in a Complex Case of Infarct-Related Cardiogenic Shock

## TL;DR

A patient with severe heart failure due to a heart attack required urgent treatment with a ventricular assist device, which later failed unexpectedly.

## Contribution

Highlights the importance of timely reassessment and device selection in managing complex cardiogenic shock cases.

## Key findings

- The patient's condition rapidly deteriorated from SCAI stage B to stage E.
- A microaxial flow pump was used for left ventricular support but malfunctioned.
- Timely reassessment of SCAI stages is crucial for guiding interventions in cardiogenic shock.

## Abstract

Infarct-related cardiogenic shock (CS) is a serious complication. The implementation of the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification system facilitates the timely identification and intervention in CS.

A patient presenting with anterior ST-segment elevation myocardial infarction arrived at the catheterization laboratory in SCAI stage B, with rapid progression to stage E. Acute bedside echocardiography revealed an ejection fraction of 10%. The patient was stabilized with norepinephrine and a microaxial flow pump. The device malfunctioned, resulting in replacement.

SCAI stages need frequent reassessment to guide appropriate interventions. The microaxial flow pump was selected owing to its less invasive nature and its ability to provide left ventricular support. The decision to implant a mechanical circulatory support device is complex and must be made swiftly in response to the patient’s clinical condition.