Mechanical Assistance for Cardiogenic Shock Following Cardiac Surgery, Myocardial Infarction, and Cardiac Transplantation

Zumbro, George L.; Kitchens, William R.; Shearer, George; Harville, G; Bailey, L.; Galloway, Ronald F.

doi:10.1016/s0003-4975(10)62344-2

Cited by 41 publications

(9 citation statements)

References 15 publications

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“…Common device-related complications include: haemorrhage, thrombus formation and embolization, stroke, device-related infection, limb ischaemia, and multi-organ dysfunction syndrome/failure [1, 2, 15, 17, 22, 23]. In our cohort, the most common procedure-related complication was major haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery

Khorsandi

Dougherty

Sinclair

et al. 2016

J Cardiothorac Surg

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BackgroundRefractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period.MethodsThe data was obtained through the Edinburgh, Glasgow and Aberdeen cardiac surgery databases. Our inclusion criteria included any adult patient from April 1995 to April 2015 who had received salvage VA ECMO or VAD for PCCS refractory to intra-aortic balloon pump (IABP) and maximal inotropic support following adult cardiac surgery.ResultsA total of 27 patients met the inclusion criteria. Age range was 34–83 years (median 51 years). There was a large male predominance (n = 23, 85 %). Overall 23 patients (85 %) received VA ECMO of which 14 (61 %) had central ECMO and 9 (39 %) had peripheral ECMO. Four patients (15 %) were treated with short-term VAD (BiVAD = 1, RVAD = 1 and LVAD = 2). The most common procedure-related complication was major haemorrhage (n = 10). Renal failure requiring renal replacement therapy (n = 7), fatal stroke (n = 5), septic shock (n = 2), and a pseudo-aneurysm at the femoral artery cannulation site (n = 1) were also observed. Overall survival to hospital discharge was 40.7 %. All survivors were NYHA class I-II at 12 months’ follow-up.ConclusionAMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate.

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Section: Discussionmentioning

confidence: 99%

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery

Khorsandi

Dougherty

Sinclair

et al. 2016

J Cardiothorac Surg

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“…Mechanical circulatory support devices are mainly implanted in patients with terminal heart failure as a bridge to heart transplantation [Farrar 1990;. Cardiogenic shock following acute myocardial infarction is a more rare indication for the implantation of an assist device [Page 1971;Zumbro 1987;Moritz 1993;Chen 1999;Reiss 1995].…”

Section: Discussionmentioning

confidence: 99%

Implantation of Cardio West Total Artificial Heart for Irreversible Acute Myocardial Infarction Shock

Morshuis¹,

Reiss²,

Arusoglu³

et al. 2007

The Heart Surgery Forum

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Patients who develop cardiogenic shock after acute myocardial infarction have a very high mortality rate despite early reperfusion therapy. Hemodynamic stabilization can often only be achieved by implanting a mechanical circulatory support system. When, in cases representing expansive myocardial impairment without any chance of recovery, pharmacological therapy and the use of percutaneous assist devices have failed, the implantation of a total artificial heart is indicated. We report our first experiences with this extensive and innovative method of managing irreversible cardiogenic shock patients. The CardioWest total artificial heart was implanted in 5 patients (male; mean age, 50 years). All patients were in irreversible cardiogenic shock despite maximum dosages of catecholamines, an intra-aortic balloon pump and/or a femoro-femoral bypass. In all patients early reperfusion therapy was performed. After implantation of the Cardio West system, all dysfunctional organ systems rapidly recovered in all patients. Four of 5 patients underwent successful heart transplantation after a mean support time of 156 days. One patient died because of enterocolic necroses caused by an embolic event after termination of dicumarol therapy. In summary, our first experiences justify this extensive management in young patients who would otherwise have died within a few hours.

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“…Recently, the use of centrifugal pumps has been increasing for extracorporeal and assisted circulation in cardiac surgery (1)(2)(3)(4). Because the change of afterload affects the blood flow in the centrifugal pump, circulation volume is decreased as the result of an increase in afterload because the resistance of peripheral blood vessels is increased.…”

Section: Discussionmentioning

confidence: 99%

The Method for Keeping Low Perfusion Flow Weaning from Centrifugal Pumps: An Evaluation of Hemolysis in the Circulator Units

Hachiro¹,

Morishita²,

Ito³

et al. 1997

Artificial Organs

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Currently, the clinical application of extracorporeal and assisted circulation using centrifugal pumps is becoming popular. However, a problem in the use of centrifugal pumps is the difficulty in controlling the flow rate when it is a low range. Although we have been controlling the flow rate with a control unit that simply squeezes the blood outlet tube from the outside, hemolysis resulting from turbulent flow in the tube was discovered. Therefore, this control procedure was evaluated experimentally. Two groups were tested as follows: in Group A (n = 10), the tube was squeezed from the outside using the control unit, and in Group B (n = 10), no control unit was used. Blood in each circuit was circulated at 1,500 rpm, and the flow rate was controlled to 250 ml/min using the control unit for Group A. Time-course changes of lactate dehydrogenase (LDH) and free hemoglobin in the blood were measured during 8 h of circulation. There were no significant differences between the 2 groups in the mean values of LDH and free hemoglobin. Therefore, the present low flow rate control provided by the control unit makes it appear to be a simple and useful apparatus for controlling blood circulation using centrifugal pumps.

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Mechanical Assistance for Cardiogenic Shock Following Cardiac Surgery, Myocardial Infarction, and Cardiac Transplantation

Cited by 41 publications

References 15 publications

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery

Implantation of Cardio West Total Artificial Heart for Irreversible Acute Myocardial Infarction Shock

The Method for Keeping Low Perfusion Flow Weaning from Centrifugal Pumps: An Evaluation of Hemolysis in the Circulator Units

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