Short-term ventricular assist device in post-cardiotomy cardiogenic shock: factors influencing survival

J Artif Organs. 2014 Sep;17(3):228-35. doi: 10.1007/s10047-014-0773-1. Epub 2014 Jun 1.

Abstract

Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support. The aim of this study was to evaluate factors influencing survival during short-term ventricular assist support in PCCS. In total, 154 CentriMag(®) (Thoratec; CA, USA) devices were implanted for cardiogenic shock between 2004 and 2011 out of which 31 were for PCCS. A retrospective review was performed in 31 PCCS patients who required the CentriMag short-term VAD as a bridge to decision. Survivors and non-survivors were compared with respect to pre- and intra-operative characteristics as well as duration of short-term VAD support. Mean duration of support was 11.7 ± 15.4 days (range 1-65 days). Seventeen (54.83 %) patients died on support, 14 (45.16 %) were weaned off or upgraded to long-term device, while 11 (35.5 %) were discharged home. The overall survival to myocardial recovery and device explantation, or upgrade to a long-term VAD, was 41.9 % (n = 13) at the study cutoff. EuroSCORE II was significantly higher in non-survivors as compared to survivors (p = 0.047). The duration of short-term VAD support was significantly longer in survivors (p < 0.001). The CentriMag is a versatile, safe and effective short-term circulatory support for patients with PCCS as a bridge to decision which enables longer support and better recovery of both heart and end-organ function and thus may improve the survival of PCCS patients. Lower EuroSCORE may be essential for myocardial recovery in PCCS.

MeSH terms

  • Equipment Design
  • Female
  • Follow-Up Studies
  • Heart Failure / mortality
  • Heart Failure / surgery*
  • Heart-Assist Devices*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / mortality*
  • Retrospective Studies
  • Risk Factors
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / therapy*
  • Survival Rate / trends
  • Treatment Outcome
  • United Kingdom / epidemiology