Timely use of a CentriMag heart assist device improves survival in postcardiotomy cardiogenic shock.

摘要

BACKGROUND: Postcardiotomy cardiogenic shock (PCS) is often fatal despite inotropic and circulatory support. We compared our experience with the CentriMag left ventricular assist device (LVAD) for patients with PCS at two time periods: in the operating room (OR) after unsuccessful weaning from cardiopulmonary bypass (CPB) and after transfer to the intensive care unit (ICU). METHODS: We reviewed 22 patients' records (13 men, nine women; age, 65 +/- 12 years) who underwent open heart surgery (January 2004 to September 2009) and required LVAD support for PCS despite maximal inotropic and intra-aortic balloon pump (IABP) support. In ten patients who could not be weaned from CPB despite high-dose inotropic therapy (>/= 3 agents) and IABP support, the CentriMag was implanted in the OR (immediate group). The other 12 patients were weaned from CPB with high-dose inotropic therapy and IABP but became increasingly unstable or had a cardiac arrest in the ICU, and the CentriMag was implanted for circulatory support (delayed group). RESULTS: Preoperatively, the average ejection fraction was 40% +/- 12%, the creatinine level was 1.6 +/- 0.6 mg/dL, and the European Systematic Coronary Risk Evaluation was 13.1 +/- 4.6. The duration of CentriMag support was 5 +/- 3 days. The immediate group had significantly better survival (7/10 vs. 2/12, p = 0.027), higher cardiac index (2.4 +/- 0.3 L/min/m(2) vs. 1.7 +/- 0.3 L/min/m(2), p = 0.001), and lower pulmonary capillary wedge pressure (20 +/- 6 mmHg vs. 29 +/- 8 mmHg, p = 0.024) than the ICU group. No perioperative complications related to device implantation occurred. CONCLUSION: In patients with PCS, timely placement of a CentriMag LVAD may increase the chance of eventual recovery.