Improvement of persistent anuria by long-term percutaneous ventricular assist device management and successful bridge to left ventricular assist device implantation in a patient with acute myocardial infarction: a case report

Cardiogenic shock secondary to acute myocardial infarction (AMI) is often complicated by acute kidney injury (AKI). Although percutaneous ventricular assist devices (pVADs) are used to treat organ failure in cardiogenic shock, it is difficult to predict whether AKI is reversible or not and how long treatment should be continued to improve renal function.

A 57-year-old woman with AMI complicated by cardiogenic and anaphylactic shock developed persistent anuria and required dialysis. Despite initial mechanical support, she remained dependent on advanced circulatory assistance. She received prolonged pVADs (Impella CP^® and Impella 5.5^®) for over 4 months. Remarkably, urine output resumed after 2 months of anuria, allowing discontinuation of dialysis. She underwent successful left ventricular assist device (LVAD) implantation on Day 138 and remained dialysis-free thereafter.

Cardiogenic shock complicated with AKI limits options for durable mechanical circulatory support. While dialysis-dependent renal dysfunction is considered a contraindication for LVAD implantation in our country, our case illustrates that recovery of renal function may still be achievable even after prolonged anuria. By maintaining renal perfusion with extended pVAD support, dialysis withdrawal was ultimately successful, enabling LVAD implantation. This case highlights that prolonged circulatory support may be a feasible bridge to durable LVAD or heart transplantation.