Robot-assisted partial nephrectomy during simultaneous extracorporeal membrane oxygenation and impella^® in a candidate for left ventricular assist device as a bridge for cardiac transplant: a case report

Francesco Cianflone¹, Giuseppe Ottone Cirulli¹, Alessio Villano¹, Mohammad Eisa Ali¹, Mirko Belliato², Roberto Veronesi², Germana Bichisao³, Carlo Marchetti¹, Simona Secondino⁴, Paolo Pedrazzoli^4,5, Stefano Pelenghi⁶, Carlo Pellegrini^6,7, Andrea Ringressi¹, Richard Naspro^1,7,*
1 Department of Urology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
2 Department of SC AR2-Anesthesia and Cardiothoracic ICU, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
3 Department of SC AR3-Anesthesia and Post-Surgical Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
4 Department of Oncology, IRCCS Policlinico San Matteo Foundation, Pavia, 27100, Italy
5 Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, Pavia, 27100, Italy
6 Cardiac Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
7 Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, via Alessandro Brambilla, 74, Pavia, 27100, Italy
* Corresponding Author: Richard Naspro. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.073002

Received 09 September 2025; Accepted 28 October 2025; Published online 28 November 2025

Abstract

Background: Robot-assisted partial nephrectomy (RAPN) is standard for cT1 renal masses, but its feasibility in patients on temporary mechanical circulatory support is poorly documented. We report RAPN performed while a patient was simultaneously supported with venous-arterial extracorporeal membrane oxygenation (VA ECMO) and Impella^®, as part of a staged plan for left ventricular assist device (LVAD) implantation and eventual heart transplantation. Case Presentation: A 51-year-old man presented with ST-elevation myocardial infarction complicated by cardiogenic shock requiring percutaneous coronary intervention with stenting, dual antiplatelet therapy, and combined VA ECMO–Impella^® support. During workup for cardiac transplant, computed tomography (CT) staging revealed a 16-mm left renal mass suspicious for renal cell carcinoma. A multidisciplinary team prioritized definitive treatment to preserve transplant eligibility and elected RAPN under systemic heparinization alongside aspirin continuation (cangrelor briefly withheld). Therefore, RAPN was performed with 9 min of warm ischemia. The intraoperative course was hemodynamically stable. On postoperative day (POD) 4, late arterial bleeding from the resection bed was controlled by selective angioembolization. On POD 7, a durable LVAD was implanted as a bridge to heart transplantation. Final pathology showed pT1a, G2, R0 clear cell renal cell carcinoma. At 6 months, contrast-enhanced CT showed no recurrence and no major cardiovascular complications. Conclusions: RAPN during simultaneous ECMO and Impella^® support is technically feasible with meticulous anticoagulation management, interventional radiology standby, and coordinated planning. This approach enables oncologic control while preserving a trajectory to transplant candidacy.

Keywords

robot-assisted partial nephrectomy (RAPN); kidney cancer; extracorporeal membrane oxygenation (ECMO); left ventricular assist device (LVAD); cardiac transplant; case report

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Robot-assisted partial nephrectomy during simultaneous extracorporeal membrane oxygenation and impella® in a candidate for left ventricular assist device as a bridge for cardiac transplant: a case report

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Robot-assisted partial nephrectomy during simultaneous extracorporeal membrane oxygenation and impella^® in a candidate for left ventricular assist device as a bridge for cardiac transplant: a case report