Ventricular Assist Device Support for High-Risk PCI in a Patient with Acute Myocardial Infarction and Cardiogenic Shock

On September 6, 2025, at Fuyang People's Hospital, a high-risk PCI was performed on a critically ill patient with support from magAssist MoyoAssist® , a temporary Ventricular Assist Device.

Patient Profile:

• Age: 69

• Gender: Male

• Medical History: Long-term type 2 diabetes with poor glycemic control (admission fasting glucose 13.8mmol/L; historical high 18.4mmol/L).

• Symptoms: Presented with sudden onset of dyspnea.

Key Findings:

• History of present illness Diagnosed with acute anterior myocardial infarction complicated by acute heart failure and cardiogenic shock; transferred from a local hospital to the Cardiac Care Unit (CCU).

• Electrocardiogram (ECG): Showed "multilead ST-T changes, paroxysmal atrial fibrillation."

• Laboratory Results: Significantly elevated cardiac troponin, NT-proBNP, and blood ketones.

• Vital Signs: Severe hypoxemia and blood pressure decreased to shock levels.

• Echocardiography (Bedside): Left ventricular ejection fraction (LVEF) was approximately 20%.

• Coronary Angiography: Revealed severe three-vessel disease:

  ￮ Left Main (LM): ~30% distal stenosis.

  ￮ Left Anterior Descending (LAD): Up to 95% stenosis, with ~60% ostial stenosis in the second diagonal branch.

  ￮ Left Circumflex (LCX): 60% proximal stenosis and a mid-segment subtotal occlusion.

  ￮ Right Coronary Artery (RCA): 50% proximo-mid stenosis, with 70%-80% proximal stenosis in the posterior left ventricular and posterior descending branches.

Diagnoses:

• Acute Anterior Myocardial Infarction

• Coronary Artery Disease

• Heart Failure, NYHA Class IV

• Cardiogenic Shock

• Type 2 Diabetes

• Pulmonary Infection

• Renal Dysfunction

• Hyperuricemia

• Ketosis

Procedure Strategy:

• The patient was assessed to be at extremely high risk for PCI due to advanced age, cardiogenic shock, and poorly controlled diabetes, which contributes to more diffuse coronary disease and impaired myocardial compensation.

• A multidisciplinary team ledtermined that mechanical circulatory support was necessary to proceed with revascularization.

• The decision was made to use the MoyoAssist® Extra VAD®, a full magnetic levitation centrifugal pump, to provide hemodynamic support. The device, capable of delivering up to 10L/min of flow, was intended to unload the left ventricle and maintain vital organ perfusion during the intervention.

Postoperative Course:

• MoyoAssist® was successfully implanted in the cardiac cathlab lab 

• Transesophageal echocardiography (TEE) was used for real-time guidance during the transseptal puncture.

• Upon device activation, the patient's blood pressure and hemodynamic parameters stabilized.

• With the patient stabilized on mechanical support, the interventional team performed PCI on the culprit vessel, restoring coronary blood flow to TIMI 3.

• The patient remained hemodynamically stable throughout the procedure and was subsequently transferred to the CCU for postoperative management.

• The patient is reported to be recovering well with ongoing support from the device and the multidisciplinary team.

Clinical Insights:

• This case demonstrates the application of a China-developed Ventricular Assist Device to facilitate high-risk PCI in a patient with cardiogenic shock and multiple severe comorbidities.

• For patients in cardiogenic shock, particularly those with conditions like diabetes that compromise organ function, mechanical circulatory support can be a critical strategy to enable safe coronary revascularization.

• The use of such technology at a municipal-level hospital indicates an advancement in regional capabilities for managing critically ill cardiovascular patients. The experience gained is valuable, though the wider clinical benefits and strategies require further accumulation and expansion.