title: Bridge to decision using the Levitronix CentriMag short-term ventricular assist device.
abstract: BACKGROUND
  Ventricular assist devices are effective in severe end-stage cardiac failure but outcomes remain poor in critically ill patients. Cheaper and less invasive short-term devices have been used in this setting. We report our experience with the Levitronix CentriMag short-term ventricular assist device as a potential bridge prior to deciding whether a more expensive device should be used or whether transplantation should be undertaken.
  
  
  METHODS
  Since August 2003, 16 moribund patients (14 males; age 32.7 +/- 14.9 [range 16 to 62] years) have been supported with the CentriMag device as a "bridge to decision." Twelve patients had an intra-aortic balloon pump pre-operatively, 13 had multi-organ failure, 11 had septic shock, and in 5 patients the neurologic status was uncertain at the time of insertion of the device.
  
  
  RESULTS
  Operative mortality was 18.7% (3 patients). Seven patients (43.7%) were reoperated for bleeding. The mean support duration was 46.9 +/- 32.3 (range 6 to 111) days. There were 2 late deaths during Levitronix utilization. Follow-up was 12.8 +/- 12.5 (range 0.6 to 43) months. Eleven patients (68.7%) are currently alive and well: 2 patients recovered and had the Levitronix device explanted; 6 patients were upgraded to a long-term device; and 3 patients were bridged directly to transplantation. The actuarial survival at 1, 6 and 12 months was 85.7%, 64.9% and 64.9%, respectively. There were no instances of device failure.
  
  
  CONCLUSIONS
  The Levitronix device is effective in rescuing critically ill "moribund" patients and can provide an opportunity for low-cost support and optimization of their condition prior to deciding whether a more expensive device should be placed or if transplantation should be undertaken. Better candidate selection for further procedures can then be allowed.
authors.affiliation: Department of Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.forename: Paula
authors.initials: P
authors.lastname: Rogers
authors.forename: Mohammed
authors.initials: M
authors.lastname: Amrani
authors.forename: Mario
authors.initials: M
authors.lastname: Petrou
authors.forename: John R
authors.initials: JR
authors.lastname: Pepper
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.forename: Gilles D
authors.initials: GD
authors.lastname: Dreyfus
authors.forename: Asghar
authors.initials: A
authors.lastname: Khaghani
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Birks
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000601:surgery*; D012772:Shock, Septic / Q000628:therapy*; D016896:Treatment Outcome