Outcome of CentriMag™ extracorporeal mechanical circulatory support use in critical cardiogenic shock (INTERMACS 1) patients

Abstract

Purpose Prognosis of patients presenting with INTERMACS 1 critical cardiogenic shock is generally poor. The aim of our study was to investigate the results of CentriMag™ extracorporeal short-term mechanical circulatory support as a bridge to decision in patients presenting with critical cardiogenic shock in our unit. Methods We retrospectively analysed 63 consecutive patients from January 2005 to June 2017, who were treated with a CentriMag™ device at our institution as a bridge to decision. Patients requiring extracorporeal support for post-cardiotomy shock and for primary graft dysfunction after heart transplantation were excluded. Results Patients’ median age was 44 years (IQR 31–52, range 15.4–62.0) and 42 (67%) were male. Primary diagnosis at presentation was ischaemic cardiomyopathy (n = 24; 38.1%), viral myocarditis (n = 19; 30.2%), idiopathic dilated cardiomyopathy (n = 8; 12.7%), and others (n = 12; 19%). The median duration of support was 25 (IQR 9.5–56) days. A total of 7 (11%) patients were supported with peripheral veno-arterial (VA) extra corporeal membrane oxygenation (ECMO), 6 (9%) with central VA ECMO, 8 (13%) with left ventricular assist device (LVAD), 17 (27%) with biventricular assist device (BiVAD), and 25 (40%) with ECMO and then converted to BiVAD. Overall, 22 (34.9%) patients died while on CentriMag™ mechanical circulatory support. Complications included bleeding requiring reoperation/intervention in 24 (38%), renal failure requiring dialysis in 29 (46%), bacterial infections in 23 (37%), fungal infections in 15 (24%), critical limb ischaemia in 6 (10%), and stroke in 8 (13%). The overall survival to successful explant from CentriMag™ was 65.1% (n = 41) and survival to hospital discharge was 58.7% (n = 37). Of these, 10 (16%) had cardiac recovery and were successfully explanted, 20 (32%) were bridged to heart transplantation, 11 (17%) were bridged to long-term left ventricular assist device, 3 (4.7%) were later on transplanted, and 1 (1.6%) recovered to decommissioning. The 1-, 5-, and 10-year survival rates were 55%, 46%, and 23% respectively. Conclusion Our results demonstrate an excellent outcome with the use of the CentriMag™ device in this seriously ill population. Despite requiring multiple procedures, over 58% of patients were discharged from hospital with 5-year survival of 46%.

Predicting outcomes following short‐term ventricular assist device implant with the MELD‐XI score

“…In this patient cohort, almost half (46%) of the patients experienced major bleeding post‐operatively. This is similar to other single‐center studies that have reported high rates of bleeding events following STCF‐VAD implantation 1–3,7,10,32 . In two studies of patients supported with CentriMag devices, 38–75% of patients experienced at least one major bleeding event with almost one‐fifth requiring re‐operation 2,32 .…”

“…This is similar to other single-center studies that have reported high rates of bleeding events following STCF-VAD implantation. [1][2][3]7,10,32 In two studies of patients supported with CentriMag devices, 38-75% of patients experienced at least one major bleeding event with almost one-fifth requiring re-operation. 2,32 In the current study, pre-implant MELD-XI scores were significantly associated with postoperative bleeding with those patients experiencing a bleed having a median MELD-XI score of 22.2 (IQR 17.1, 30.0).…”

“…Short‐term continuous flow (STCF) ventricular assist devices (VADs), although a rare form of cardiac support, are increasingly being utilized in adult patients with cardiogenic shock. These devices can act as a bridge to recovery, decision, transplant, or conversion to long‐term VAD 1–7 . As STCF‐VAD patients are often critically ill, there is high risk for post‐operative complications and mortality 1,4,7–11 .…”

“…These devices can act as a bridge to recovery, decision, transplant, or conversion to long-term VAD. [1][2][3][4][5][6][7] As STCF-VAD patients are often critically ill, there is high risk for post-operative complications and mortality. 1,4,[7][8][9][10][11] The Model for End-Stage Liver Disease (MELD) score was developed to predict survival in patients undergoing shunt procedures for liver disease.…”

Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure

“…During biventricular support, major bleedings may affect 20–40% of patients [ 27 , 28 ] and our preliminary findings showed a 17% rate of bleedings (non-fatal bronchial hemorrhage) that required intervention during RVAD + LVAD support. On the contrary, thrombotic events never occurred during biventricular support in our experience.…”