title: Bridge-to-decision therapy with a continuous-flow external ventricular assist device in refractory cardiogenic shock of various causes.
abstract: BACKGROUND
  Mortality for refractory cardiogenic shock remains high. In this patient cohort, there have been mixed results in mechanical circulatory support device use as a bridge-to-decision therapy. We evaluated a continuous-flow external ventricular assist device (VAD), CentriMag VAD (Thoratec Corp., Pleasanton, CA), in patients with various causes of refractory cardiogenic shock.
  
  
  RESULTS
  This is a retrospective review of adult patients who underwent surgical CentriMag VAD insertion as bridge-to-decision therapy. From January 2007 through June 2012, 143 patients received CentriMag VAD. The cause of refractory cardiogenic shock was failure of medical management in 71 patients, postcardiotomy shock in 37, graft failure post-heart transplantation in 22, and right ventricular failure post-implantable left VAD in 13. Mean age was 52±16 years, and 71% were in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 1. Among 158 device runs, device configuration was BiVAD in 67%, isolated right VAD in 26%, and isolated left VAD in 8%. Median duration of support was 14 days (interquartile range, 8-26). Survival was 69% at 30 days and 49% at 1 year. The next destination after the CentriMag VAD was myocardial recovery in 30%, device exchange to an implantable VAD in 15%, and heart transplantation in 18%. The failure of medical management and the graft failure post-heart transplantation groups had higher 30-day survival compared with the postcardiotomy shock group. Major bleeding events occurred in 33% and cerebrovascular accidents in 14%. There was no CentriMag pump failure or thrombosis.
  
  
  CONCLUSIONS
  Bridge-to-decision therapy with CentriMag VAD is feasible in a variety of refractory cardiogenic shock settings. Patients with postcardiotomy shock have inferior survival.
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY. hirofu2@hotmail.com.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Lori
authors.initials: L
authors.lastname: Soni
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Truby
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Sophia
authors.initials: S
authors.lastname: Cedola
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Zain
authors.initials: Z
authors.lastname: Khalpey
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Paolo
authors.initials: P
authors.lastname: Colombo
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: From the Departments of Surgery (H.T., L.S., B.K., L.K.T., T.O., S.C., Z.K., Y.N.) and Medicine (N.U., P.C., D.M.M., U.P.J.), Columbia University Medical Center, New York, NY.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D011474:Prosthesis Design; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends
keywords: heart-assist devices; shock, cardiogenic