Use of the percutaneous left ventricular assist device in patients with severe refractory cardiogenic shock as a bridge to long-term left ventricular assist device implantation.
BACKGROUND
For patients with persistent cardiogenic shock refractory to intraaortic balloon pump (IABP) support, there are only limited means of resuscitation and bridging to surgical left ventricular assist device (LVAD) implantation. Extracorporeal membrane oxygenation and emergency surgical approaches have been attempted but are associated with significant morbidity and mortality. We evaluated the efficacy of a percutaneous left ventricular assist device (PVAD) as a bridge to LVAD implantation in patients in cardiogenic shock refractory to IABP and pressor support.


METHODS
Between May 2003 and April 2006, at our institution, 18 patients in severe refractory cardiogenic shock received a PVAD as a bridge to LVAD placement or orthotopic heart transplantation. Six patients had ischemic cardiomyopathy, and 12 had nonischemic cardiomyopathy. At the time of PVAD placement, 17 were receiving IABP support, and 10 were undergoing cardiopulmonary resuscitation.


RESULTS
The mean duration of PVAD support was 4.2 +/- 2.5 days. During this time, the cardiac index improved from 0.86 +/- 0.66 to 2.50 +/- 0.93 liters/min/m2 (p < 0.001), systolic blood pressure improved from 72 +/- 11 to 98 +/- 15 mm Hg (p = 0.001), and systemic mixed venous oxygenation improved from 37 +/- 7 to 62 +/- 6 mm Hg (p < 0.001). We terminated life support in 4 of the 18 patients before LVAD placement; 14 were successfully bridged to LVAD or heart transplantation. The mortality rate was 27% at 30 days and 33% at 6 months. There were no PVAD-associated deaths.


CONCLUSIONS
In patients with terminal hemodynamic collapse, PVAD support is an effective bridging therapy to LVAD and appears to be a viable alternative to other invasive methods of support.
Idelchik
Gary M
GM
Division of Cardiology, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. idelchik@yahoo.com
Simpson
Leo
L
Civitello
Andrew B
AB
Loyalka
Pranav
P
Gregoric
Igor D
ID
Delgado
Reynolds
R
Kar
Biswajit
B
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome