Original clinical scienceClinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era
Section snippets
Methods
This study is a retrospective review of the charts of the consecutive patients who received an MCSD for RCS from January 2007 through January 2012. Those patients who received the device for post-cardiotomy shock or post-transplant cardiac graft dysfunction were excluded from the analysis, as their pathophysiology is quite different from those who develop RCS without going through cardiac surgery. Demographics, hemodynamics and biochemical values (all prior to MCS) were collected from patients’
Statistical analysis
Mean values and standard deviations (SDs) were determined for continuous variables. Categorical variables were presented and compared as numbers and percentages. The distribution of all variables was tested for normality, and non-parametric testing was done to analyze the data. All skewed parameters are presented as median and interquartile range (IQR), whereas all non-skewed parameters are presented as mean±SD. Paired t-tests were used for analysis between continuous non-skewed variables and
Results
During the study period, 90 patients received MCS for RCS. The etiology of RCS included acute myocardial infarction in 49%, acute decompensated heart failure in 27%, and myocarditis in 8% (Table 1). Mean age was 53±14 years, 71% were male, 60% had an IABP, and 23% were undergoing active CPR at insertion of the MCSD (Table 2). Hemodynamics data to calculate cardiac power output (watts) (mean arterial pressure×cardiac output/ 451) were available for 38 patients. The mean cardiac power output of
Discussion
In this study we have addressed the outcomes of device therapy in RCS, focusing on experience from the last 5 years. The major findings are that: (1) 49% of patients survived to hospital discharge; (2) 48% of patients who survived to the next destination required device exchange to implantable VAD; and (3) overall 1-year survival was 46%.
It is important to emphasize that, contrary to previous reports describing the outcomes of device therapy in CS, this study has addressed the outcomes of one
Disclosure statement
U.P.J. and Y.N. have received consulting fees from Thoratec Corp. The remaining authors have no conflicts of interest to disclose.
References (22)
- et al.
Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification
J Heart Lung Transplant
(2011) - et al.
Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support
J Thorac Cardiovasc Surg
(2011) - et al.
Initial experience with the Abiomed AB5000 ventricular assist device system
Ann Thorac Surg
(2005) - et al.
Less invasive left ventricular assist device placement for difficult resternotomy
J Thorac Cardiovasc Surg
(2010) - et al.
The CentriMag ventricular assist device in acute heart failure refractory to medical management
J Heart Lung Transplant
(2012) - et al.
The percutaneous ventricular assist device in severe refractory cardiogenic shock
J Am Coll Cardiol
(2011) - et al.
Comparative outcomes in cardiogenic shock patients managed with Impella microaxial pump or extracorporeal life support
J Thorac Cardiovasc Surg
(2011) - et al.
Cardiac power output predicts mortality across a broad spectrum of patients with acute cardiac disease
Am Heart J
(2007) - et al.
Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry
J Am Coll Cardiol
(2004) - et al.
Temporal trends in cardiogenic shock complicating acute myocardial infarction
N Engl J Med
(1999)
Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation
Circulation
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