title: Bridge to transplant or recovery in cardiogenic shock in a developing country.
abstract: Background Durable mechanical support devices are prohibitively expensive in our health system and may be unsuitable for critically ill patients. CentriMag is an alternative bridge to transplantation or recovery. Methods We retrospectively reviewed 28 patients (23 males) aged 13-60 years who received CentriMag support. The etiology was ischemic in 13 (46%), dilated cardiomyopathy in 8 (29%), and others in 7 (25%). All patients were in Interagency Registry for Mechanically Assisted Circulatory Support class I, and 27 (96%) had multiorgan failure; 2 (7%) were post-cardiotomy and 12 (43%) had a previous cardiac arrest (mean arrest time 21 ± 17 min). Results Thirty-day post-implant survival was 79% (22 patients). Twenty (71%) patients were successfully bridged to transplantation or recovery. The mean support time was 40 days; 12 (43%) patients had >4-weeks' support (longest was 292 days). Eight (29%) patients died on support. Complications included bleeding in 10 (36%) cases, immediate stroke in 4 (14%), and dialysis in 8 (29%). There was no stroke during subsequent support. Eighteen (64%) patients underwent transplantation, and 17 of them were discharged. Two (7%) patients recovered and were discharged. Two-year survival was 62% ± 10%. Mean follow-up was 21 months (total follow-up 579 months). Two (7%) patients died during follow-up. All survivors were in New York Heart Association class I. Conclusions CentriMag is useful for medium-term support for cardiogenic shock in a developing country. Support for >4 weeks is feasible. The stroke rate is low during support. The major drawback is prolonged intensive care unit stay.
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.|2 Cardiovascular Surgery Service, Instituto Nacional del Tórax, Santiago, Chile.|3 Department of Surgery and Medicine, Universidad de Chile, Santiago, Chile.
authors.forename: Mauricio A
authors.initials: MA
authors.lastname: Villavicencio
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Larraín
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Larrea
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Peralta
authors.affiliation: 2 Cardiovascular Surgery Service, Instituto Nacional del Tórax, Santiago, Chile.
authors.forename: Jong S
authors.initials: JS
authors.lastname: Lim
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.
authors.forename: Pamela
authors.initials: P
authors.lastname: Rojo
authors.affiliation: 2 Cardiovascular Surgery Service, Instituto Nacional del Tórax, Santiago, Chile.
authors.forename: Erika
authors.initials: E
authors.lastname: Donoso
authors.affiliation: 2 Cardiovascular Surgery Service, Instituto Nacional del Tórax, Santiago, Chile.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gajardo
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.
authors.forename: Margarita
authors.initials: M
authors.lastname: Hurtado
authors.affiliation: 1 Department of Cardiovascular Diseases, Clínica Dávila, Santiago, Chile.|3 Department of Surgery and Medicine, Universidad de Chile, Santiago, Chile.
authors.forename: Víctor
authors.initials: V
authors.lastname: Rossel
mesh_terms: D000293:Adolescent; D000328:Adult; D002677:Chile; D016638:Critical Illness; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult
keywords: Chile; Extracorporeal membrane oxygenation; Heart transplantation; Heart-assist devices; Multiple organ failure; Shock; cardiogenic