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  • Editorial: Unloading a Broken Heart: Impella Support for Takotsubo Syndrome Complicated by Cardiogenic Shock

    Despite advances in coronary reperfusion and systems of care delivery models, cardiogenic shock ( CS ) remains the leading cause of death following acute myocardial infarction ( AMI ), with short-term mortality rates in excess of 40%  . CS is multifactorial, with contemporary shock registries suggesting that non-ischemic etiologies spanning the spectrum of congestive and hemodynamic derangements account for >50% of all shock cases  . While there has been a significant uptake in the utilization of mechanical circulatory support ( MCS ) devices to stabilize hemodynamics in shock, variations in regional and inter-operator expertise with the deployment and management of these platforms endure  . Notwithstanding their capability to reduce intra-cardiac filling pressures and stroke work through pressure-volume loop interactions, a clear survival benefit has yet to be demonstrated with the unrestricted deployment of these devices in CS  . This is in part due to potential complications inherent with large bore access, including bleeding, vascular complications, renal failure and stroke  . Heightened recognition of the multi-organ system complexities of CS and challenges associated with complications stemming from MCS devices has led to the implementation of shock teams at dedicated tertiary and quaternary care centers to provide full-spectrum and longitudinal care, including management of temporizing MCS, for this frail and vulnerable patient population  .

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