Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute—and know how to use all three

Stein, Louis H.; Silvestry, Scott C.

doi:10.1016/j.xjon.2021.10.055

Cited by 6 publications

(6 citation statements)

References 38 publications

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“…Also noteworthy, pioneering models have been developed to predict the risk of low cardiac output syndrome and/or demand for tMCS as a result of PCCS [84,85]. Models have also been developed to add rigor to decisions such as separating from tMCS [86][87][88][89].…”

Section: Risk Assessmentmentioning

confidence: 99%

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

Lobdell,

Grant,

Salenger

2023

Current Opinion in Anaesthesiology

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Purpose of review This review highlights the integration of enhanced recovery principles with temporary mechanical circulatory support associated with adult cardiac surgery. Recent findings Enhanced recovery elements and efforts have been associated with improvements in quality and value. Temporary mechanical circulatory support technologies have been successfully employed, improved, and the value of their proactive use to maintain hemodynamic goals and preserve long-term myocardial function is accruing. Summary Temporary mechanical circulatory support devices promise to enhance recovery by mitigating the risk of complications, such as postcardiotomy cardiogenic shock, organ dysfunction, and death, associated with adult cardiac surgery.

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Section: Risk Assessmentmentioning

confidence: 99%

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

Lobdell,

Grant,

Salenger

2023

Current Opinion in Anaesthesiology

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“…The cornerstone of our programmatic approach to performing CABG in high-risk ICM patients is the use of planned temporary MCS at the time of surgery, together with an identified exit strategy. 30,32 The value of temporary MCS is not only in salvage situations but also in prophylactic implantation to support the dysfunctional LV through the critical phase of organ recovery postoperatively. 7 At our institution, the preferred temporary MCS device for pre-emptive support of high-risk CABG candidates is the Impella 5.5, as it actively unloads the LV and reduces myocardial oxygen consumption while supporting systemic perfusion.…”

Section: Preoperative Strategiesmentioning

confidence: 99%

“…Lastly, echocardiography provides details of valvular function, which guides our preference for aggressive repair of valvular lesions. Importantly, aortic stenosis or the presence of a mechanical aortic valve should also be noted, as this potentially limits the use of transvalvular temporary MCS devices 32 …”

Section: Systematic Evaluation Of High‐risk Ischemic Cardiomyopathy P...mentioning

confidence: 99%

“…The cornerstone of our programmatic approach to performing CABG in high‐risk ICM patients is the use of planned temporary MCS at the time of surgery, together with an identified exit strategy 30,32 . The value of temporary MCS is not only in salvage situations but also in prophylactic implantation to support the dysfunctional LV through the critical phase of organ recovery postoperatively 7 .…”

Section: Programmatic Approach To Surgical Revascularization Of High‐...mentioning

confidence: 99%

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Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era

Maigrot,

Weiss,

Tong

et al. 2023

Artificial Organs

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Patients with advanced ischemic cardiomyopathy manifesting as left ventricular dysfunction exist along a spectrum of severity and risk, and thus decision‐making surrounding optimal management is challenging. Treatment pathways can include medical therapy as well as revascularization through percutaneous coronary intervention or coronary artery bypass grafting. Additionally, temporary and durable mechanical circulatory support, as well as heart transplantation, may be optimal for select patients. Given this spectrum of risk and the complexity of treatment pathways, patients may not receive appropriate therapy given their perceived risk, which can lead to sub‐satisfactory outcomes. In this review, we discuss the identification of high‐risk ischemic cardiomyopathy patients, along with our programmatic approach to patient evaluation and perioperative optimization. We also discuss our strategies for therapeutic decision‐making designed to optimize both short‐ and long‐term patient outcomes.

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“…Cardiogenic shock (CS) in patients following cardiac surgery (postcardiotomy cardiogenic shock, PCCS) is a highly relevant but complex diagnosis. CS after heart surgery refers to a critical hemodynamic state of patients where weaning from cardiopulmonary bypass (CPB) is not possible or a persistent low cardiac output syndrome occurs during or after the cardiac procedure [1]. Although the incidence of PCCS is around 1-5%, it is associated with a considerable hospital mortality rate of over 60% [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients after Cardiac Procedures: Selection Algorithm and Weaning Strategies

Nersesian,

Ott,

Fardman

et al. 2023

Life

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Mechanical circulatory support has proven effective in managing postcardiotomy cardiogenic shock by stabilizing patients’ hemodynamics and ensuring adequate organ perfusion. Among the available device modalities, the combination of extracorporeal life support and a microaxial flow pump for left ventricular unloading has emerged as a valuable tool in the surgical armamentarium. In this publication, we provide recommendations for the application and weaning of temporary mechanical circulatory support in cardiogenic shock patients, derived from a consensus among leading cardiac centers in German-speaking countries.

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Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute—and know how to use all three

Cited by 6 publications

References 38 publications

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era

Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients after Cardiac Procedures: Selection Algorithm and Weaning Strategies

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