Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2016 Nov 8;11(1):151.
doi: 10.1186/s13019-016-0545-5.

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

Maziar Khorsandi  1 , Scott Dougherty  2 , Andrew Sinclair  3 , Keith Buchan  4 , Fiona MacLennan  3 , Omar Bouamra  5 , Philip Curry  3 , Vipin Zamvar  6 , Geoffrey Berg  3 , Nawwar Al-Attar  3
Affiliations
Multicenter Study

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

Maziar Khorsandi et al. J Cardiothorac Surg. .

Abstract

Background: Refractory 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.

Methods: The 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.

Results: A 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.

Conclusion: AMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate.

Keywords: Extracorporeal circulation; Heart-assist devices; Post-cardiotomy; Shock.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Bar chart illustrating the number and nature of complications within cohort
Fig. 2
Fig. 2
Bar chart illustrating the number and causes of death within cohort. AV: atrioventricular
Fig. 3
Fig. 3
Kaplan-Meier curve of survival, x-axis represents follow-up (FU) in days and y-axis represents cumulative survival (Cum survival)
See this image and copyright information in PMC

References

    1. Muehrcke DD, McCarthy PM, Stewart RW, Foster RC, Ogella DA, Borsh JA, et al. Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Ann Thorac Surg. 1996;61(2):684–91. doi: 10.1016/0003-4975(95)01042-4. - DOI - PubMed
    1. DeRose JJ, Jr, Umana JP, Argenziano M, Catanese KA, Levin HR, Sun BC, et al. Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices. Ann Thorac Surg. 1997;64(6):1757–62. doi: 10.1016/S0003-4975(97)01107-7. - DOI - PubMed
    1. Hernandez AF, Grab JD, Gammie JS, O’Brien SM, Hammill BG, Rogers JG, et al. A decade of short-term outcomes in post cardiac surgery ventricular assist device implantation: data from the Society of Thoracic Surgeons' National Cardiac Database. Circulation. 2007;116(6):606–12. doi: 10.1161/CIRCULATIONAHA.106.666289. - DOI - PubMed
    1. Mohite PN, Sabashnikov A, Patil NP, Saez DG, Zych B, Popov AF, et al. Short-term ventricular assist device in post-cardiotomy cardiogenic shock: factors influencing survival. J Artif Organs. 2014;17(3):228–35. doi: 10.1007/s10047-014-0773-1. - DOI - PubMed
    1. Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139(2):302–11. doi: 10.1016/j.jtcvs.2009.10.043. - DOI - PubMed

Publication types

Substances