title: Short-term ventricular assist device as a bridge to decision in cardiogenic shock: is it a justified strategy?
abstract: OBJECTIVE
  Low cardiac output syndrome is associated with significant mortality. In patients with refractory low cardiac output left ventricular assist devices (VAD) are used to re-establish cardiac output and to prevent death. However, long-term LVAD implantation in these is complicated by a high rate of right heart failure and mortality. Therefore, our strategy is to implant a short-term VAD (left or biventricular) as a bridge to decission.
  
  
  METHODS
  We retrospectively analysed data from 66 patients who received a short-term LVAD support prior to implantation of a long-term LVAD or HTx between 2003 and 2014. We performed short-term LVAD (CentriMag; Thoratec) implantation via median sternotomy with percutaneous cannulas. Patients were included regardless of perioperative status and severity of heart failure. Patients suffering postcardiotomy cardiogenic shock, receiving isolated RVAD as well as posttransplant patients were excluded from this study.
  
  
  RESULTS
  Mean duration of support in the survivor group was 35 ± 25 days versus 25 ± 25 days in the nonsurvivor group (n.s.), range from 1 to 109 days. The overall survival on support was 40 (60%) patients. In the survivor group 12 patients could be successfully weaned from the system, 12 patients received a heart transplant and in 16 a long-term VAD was implanted. In the nonsurvivor group the rate of preoperative extracorporeal life support, the rate of postoperative renal failure and multiorgan failure was significantly higher.
  
  
  CONCLUSIONS
  Thanks to its capacity for full ventricular support, short-term univentricular or biventricular LevotronixCentriMag VAD currently represents an ideal solution for bridge-to-decision.
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Prashant
authors.initials: P
authors.lastname: Mohite
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Binu
authors.initials: B
authors.lastname: Raj
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Javid
authors.initials: J
authors.lastname: Fatullayev
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Diana Garcia
authors.initials: DG
authors.lastname: Saez
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Bartrlomiej
authors.initials: B
authors.lastname: Zych
authors.affiliation: Heart and Vascular Institute, Pennstate Hershey, Philadelphia - USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Ghodsizad
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne - Germany.
authors.forename: Parwis
authors.initials: P
authors.lastname: Rahmanian
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne - Germany.
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne - Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Andre R
authors.initials: AR
authors.lastname: Simon
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Aron F
authors.initials: AF
authors.lastname: Popov
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield - UK.
authors.forename: Achim
authors.initials: A
authors.lastname: Koch
mesh_terms: D000328:Adult; D002302:Cardiac Output; D000066491:Clinical Decision-Making; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery*; D056346:Sternotomy; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult