Mechanical Support for Postcardiotomy Cardiogenic Shock: Has Progress Been Made?

Abstract

Postcardiotomy cardiogenic shock (PCCS) complicates 0.2% to 6% of cardiac operations and is a clinical entity fraught with considerable morbidity and mortality. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. In the interim, newer technologies have entered the clinical arena. Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center.

Results of mechanical circulatory support in France

“…However, a distinction has to be made between different particular situations, one of which is MCS implementation for refractory cardiogenic shock occurring in the postoperative phase following conventional cardiac surgery or after cardiac transplantation with primary graft failure. In these specific settings, mortality rates are particularly high and in line with those reported in scientific literature [6]. As a result, we should use in this particular indication less expensive systems that are easy to implement such as long-term extracorporeal circulation, although this does not always lead to better results [7,8].…”

Management of Acute Cardiac Failure by Intracoronary Administration of Levosimendan

“…In contrast, the literature reports an average 30-day mortality of about 50%-80% with a significant number of patients requiring treatment with temporary circulatory support devices or an IABP but with no substantial improvement in overall survival. [29][30][31] Our study utilizes a particularly attractive human model (intraoperative cardiogenic failure) to evaluate the direct and indirect effects of IC levosimendan administration on acute heart failure and reperfusion damage. As previously reported by Caimmi et al, 14 in a recent experimental article, IC levosimendan administration at the onset of reperfusion exerts beneficial cardiac effects through the modulation of myocardial cell death and the activation of components of the RISK pathway, such as Akt and ERK1/2.…”

Combined pulmonary and left ventricular support with veno-pulmonary ECMO and impella 5.0 for cardiogenic shock after coronary surgery

“…IABP is the most widely used form of mechanical support. However, it lacks active cardiac support and requires a residual level of left ventricular function [6]. …”