title: Short-term ventricular assist device in post-cardiotomy cardiogenic shock: factors influencing survival.
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.
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UB9 6JH, UK, drprashantis@rediffmail.com.
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Mohite
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Patil
authors.forename: Diana García
authors.initials: DG
authors.lastname: Sáez
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Zych
authors.forename: Aron F
authors.initials: AF
authors.lastname: Popov
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Nandor
authors.initials: N
authors.lastname: Marczin
authors.forename: Fabio
authors.initials: F
authors.lastname: DeRobertis
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
mesh_terms: D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology