TY  - EJOU
AU  - Cianflone, Francesco 
AU  - Cirulli, Giuseppe Ottone 
AU  - Villano, Alessio 
AU  - Ali, Mohammad Eisa 
AU  - Belliato, Mirko 
AU  - Veronesi, Roberto 
AU  - Bichisao, Germana 
AU  - Marchetti, Carlo 
AU  - Secondino, Simona 
AU  - Pedrazzoli, Paolo 
AU  - Pelenghi, Stefano 
AU  - Pellegrini, Carlo 
AU  - Ringressi, Andrea 
AU  - Naspro, Richard 

TI  - Robot-assisted partial nephrectomy during simultaneous extracorporeal membrane oxygenation and impella<sup>®</sup> in a candidate for left ventricular assist device as a bridge for cardiac transplant: a case report
T2  - Canadian Journal of Urology

PY  - 2026
VL  - 33
IS  - 2
SN  - 1488-5581

AB  -  <b>Background:</b> 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<sup>®</sup>, as part of a staged plan for left ventricular assist device (LVAD) implantation and eventual heart transplantation. <b>Case Presentation:</b> 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<sup>®</sup> 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. <b>Conclusions:</b> RAPN during simultaneous ECMO and Impella<sup>®</sup> 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.
KW  - robot-assisted partial nephrectomy (RAPN); kidney cancer; extracorporeal membrane oxygenation (ECMO); left ventricular assist device (LVAD); cardiac transplant; case report

DO  - 10.32604/cju.2025.073002