Abstract
Significant progress has been made in the use of mechanical circulatory support (MCS), particularly in the clinical success in durable left ventricular assist device. Short-term MCS has also advanced in the form of venoarterial extracorporeal membrane oxygenation, external centrifugal VADs as well as percutaneous VADs. Postcardiotomy shock (PCS) is a rare clinical entity associated with substantial morbidity and mortality. It is characterized by heart failure that either results in an inability to wean from cardiopulmonary bypass or that occurs in the immediate postoperative period, accounting for the most common indication for MCS. The reported in-hospital mortality of the PCS patients remains high, consistently over 50 %, despite ongoing refinements of MCS technology. The optimization of selection criteria and the prompt institution of MCS are likely the keys to improving this persistently high mortality rate. Unfortunately, the lack of a clear definition for PCS in the literature limits scientific analyses and comparison of the existing evidence. To establish the treatment strategy and appropriately manage this challenging disease, substantial and fundamental effort by the cardiovascular society is imperative.
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Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2009: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2011;59:636–67.
Mehta SM, Aufiero TX, Pae WE Jr, Miller CA, Pierce WS. Results of mechanical ventricular assistance for the treatment of post cardiotomy cardiogenic shock. ASAIO J. 1996;42:211–8.
Paul S, Leacche M, Unic D, Couper GS, Macgillivray TE, Agnihotri AK, Cohn LH, et al. Determinants of outcomes for postcardiotomy VAD placement: an 11-year, two-institution study. J Card Surg. 2006;21:234–7.
Curtis JJ, McKenney-Knox CA, Wagner-Mann CC. Postcardiotomy centrifugal assist: a single surgeon’s experience. Artif Organs. 2002;26:994–7.
Rastan AJ, Dege A, Mohr M, 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;139:302.
Saxena P, Neal J, Joyce LD, Greason KL, Schaff HV, Guru P, et al. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: the Mayo Clinic experience. Ann Thorac Surg. 2015;99:2053–60.
Teman NR, Demos DS, Reames BN, Pagani FD, Haft JW. Outcomes after transfer to a tertiary center for postcardiotomy cardiopulmonary failure. Ann Thorac Surg. 2014;98:84–9.
Truby L, Mundy L, Kalesan B, Kirtane A, Colombo PC, Takeda K, et al. Contemporary outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock at a large tertiary care center. ASAIO J. 2015;61:403–9.
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;116:606–12.
Takayama H, Soni L, Kalesan B, Truby LK, Ota T, Cedola S, Khalpey Z, Uriel N, Colombo P, Mancini DM, Jorde UP, Naka Y. Bridge-to-decision therapy with a continuous-flow external ventricular assist device in refractory cardiogenic shock of various causes. Circ Heart Fail. 2014;7:799–806.
Sylvin EA, Stern DR, Goldstein DJ. Mechanical support for postcardiotomy cardiogenic shock: has progress been made? J Card Surg. 2010;25:442–54.
Li CL, Wang H, Jia M, Ma N, Meng X, Hou XT. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg. 2015;149:1445–50.
Flécher E, Anselmi A, Corbineau H, Langanay T, Verhoye JP, Félix C, et al. Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up. Eur J Cardiothorac Surg. 2014;46:665–71.
Gottfried R, Paluszkiewicz L, Kizner L, Morshuis M, Koertke H, Gummert J. Thrombosis of a bioprosthetic mitral valve under extracorporeal membrane oxygenation: thrombus formation in the left heart. Ann Thorac Surg. 2012;94:657.
Hausmann H, Potapov EV, Koster A, Krabatsch T, Stein J, Yeter R, Kukucka M, et al. Prognosis after the implantation of an intra-aortic balloon pump in cardiac surgery calculated with a new score. Circulation. 2002;106:I203–6.
Magovern GJ, Simpson KA. Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg. 1999;68:655–61.
Lemaire A, Anderson MB, Lee LY, Scholz P, Prendergast T, Goodman A, Lozano AM, Spotnitz A, Batsides G. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg. 2014;97:133–8.
Griffith BP, Anderson MB, Samuels LE, Pae WE Jr, Naka Y, Frazier OH. The RECOVER I: a multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support. J Thorac Cardiovasc Surg. 2013;145:548–54.
Doll N, Kiaii B, Borger M, Bucerius J, Krämer K, Schmitt DV, et al. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg. 2004;77:151–7.
Fiser SM, Tribble CG, Kaza AK, Long SM, Zacour RK, Kern JA, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001;71:210–4.
Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg. 2002;73:538–45.
Pagani FD, Aaronson KD, Swaniker F, Bartlett RH. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001;71:S77–81.
Smith C, Bellomo R, Raman JS, Matalanis G, Rosalion A, Buckmaster J, et al. An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population. Ann Thorac Surg. 2001;71:1421–7.
Smedira NG, Blackstone EH. Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg. 2001;71(3 Suppl):S82–5, S60–6.
Bakhtiary F, Keller H, Dogan S, Dzemali O, Oezaslan F, Meininger D, et al. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg. 2008;135:382–8.
Zhang R, Kofidis T, Kamiya H, Shrestha M, Tessmann R, Haverich A, et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg. 2006;30:617–20.
Pokersnik JA, Buda T, Bashour CA, Gonzalez-Stawinski GV. Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock? J Card Surg. 2012;27:246–52.
Takayama H, Landes E, Truby L, Fujita K, Kirtane AJ, Mongero L, et al. Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2015;149:1428–33.
Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97:610–6.
Park SC, Neches WH, Mullins CE, Girod DA, Olley PM, Falkowski G, et al. Blade atrial septostomy: collaborative study. Circulation. 1982;66:258–66.
Barbone A, Malvindi PG, Ferrara P, Tarelli G. Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg. 2011;13:293–5.
Cheng A, Swartz MF, Massey HT. Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation. ASAIO J. 2013;59:533–6.
John R, Long JW, Massey HT, Griffith BP, Sun BC, Tector AJ, et al. Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support. J Thorac Cardiovasc Surg. 2011;141:932–9.
Goldstein DJ, Oz MC. Mechanical support for postcardiotomy cardiogenic shock. Semin Thorac Cardiovasc Surg. 2000;12:220–8.
Peura JL, Colvin-Adams M, Francis GS, Grady KL, Hoffman TM, Jessup M, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126:2648–67.
Guyton RA, Schonberger JP, Everts PA, Jett GK, Gray LA Jr, Gielchinsky I, et al. Postcardiotomy shock: clinical evaluation of the BVS 5000 biventricular support system. Ann Thorac Surg. 1993;56:346–56.
Takayama H, Naka Y, Jorde UP, Stewart AS. Less invasive left ventricular assist device placement for difficult resternotomy. J Thorac Cardiovasc Surg. 2010;140:932–3.
Takayama H, Naka Y, Kodali SK, Vincent JA, Addonizio LJ, Jorde UP, Williams MR. A novel approach to percutaneous right-ventricular mechanical support. Eur J Cardiothorac Surg. 2012;41:423–6.
Takayama H, Chen JM, Jorde UP, Naka Y. Implantation technique of the centrimag biventricular assist device allowing ambulatory rehabilitation. Interact Cardiovasc Thorac Surg. 2011;12:110–1.
Mohite PN, Zych B, Popov AF, Sabashnikov A, Sáez DG, Patil NP, et al. CentriMag short-term ventricular assist as a bridge to solution in patients with advanced heart failure: use beyond 30 days. Eur J Cardiothorac Surg. 2013;44:e310–5.
Brinkman WT, Rosenthal JE, Eichhorn E, Dewey TM, Magee MJ, Savor DS, et al. Role of a percutaneous ventricular assist device in decision making for a cardiac transplant program. Ann Thorac Surg. 2009;88:1462–6.
Siegenthaler MP, Brehm K, Strecker T, Hanke T, Nötzold A, Olschewski M, et al. The Impella Recover microaxial left ventricular assist device reduces mortality for postcardiotomy failure: a three-center experience. J Thorac Cardiovasc Surg. 2004;127:812–22.
Jurmann MJ, Siniawski H, Erb M, Drews T, Hetzer R. Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure. Ann Thorac Surg. 2004;77:1642–7.
Gregoric ID, Jacob LP, La Francesca S, Bruckner BA, Cohn WE, Loyalka P, et al. The TandemHeart as a bridge to a long-term axial-flow left ventricular assist device (bridge to bridge). Tex Heart Inst J. 2008;35:125–9.
Kar B, Adkins LE, Civitello AB, Loyalka P, Palanichamy N, Gemmato CJ, et al. Clinical experience with the TandemHeart percutaneous ventricular assist device. Tex Heart Inst J. 2006;33:111–5.
Pitsis AA, Visouli AN, Burkhoff D, Dardas P, Mezilis N, Bougioukas G, Filippatos G. Feasibility study of a temporary percutaneous left ventricular assist device in cardiac surgery. Ann Thorac Surg. 2007;84:1993–9.
Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, et al. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant. 2014;33:555–64.
BoyleAJ AscheimDD, RussoMJ Kormos RL, JohnR NakaY, et al. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by preoperative INTERMACS classification. J Heart Lung Transplant. 2011;30:402–7.
Pawale A, Pinney S, Ashley K, Flynn R, Milla F, Anyanwu AC. Implantable left ventricular assist devices as initial therapy for refractory postmyocardial infarction cardiogenic shock. Eur J Cardiothorac Surg. 2013;44:213–6.
Samuels LE, Kaufman MS, Thomas MP, Holmes EC, Brockman SK, Wechsler AS, et al. Pharmacological criteria for ventricular assist device insertion following postcardiotomy shock: experience with the Abiomed BVS system. J Card Surg. 1999;14:288–93.
Akay MH, Gregoric ID, Radovancevic R, Cohn WE, Frazier OH. Timely use of a CentriMag heart assist device improves survival in postcardiotomy cardiogenic shock. J Card Surg. 2011;26:548–52.
Javidfar J, Brodie D, Takayama H, Mongero L, Zwischenberger J, Sonett J, Bacchetta M. Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center. ASAIO J. 2011;57:421–5.
Baldwin RT, Slogoff S, Noon GP, Sekela M, Frazier OH, Edelman SK, et al. A model to predict survival at time of postcardiotomy intraaortic balloon pump insertion. Ann Thorac Surg. 1993;55:908–13.
Arafa OE, Pedersen TH, Svennevig JL, Fosse E, Geiran OR. Intraaortic balloon pump in open heart operations: 10-year follow-up with risk analysis. Ann Thorac Surg. 1998;65:741–7.
Wang SS, Chen YS, Ko WJ, Chu SH. Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock. Artif Organs. 1996;20:1287–91.
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;61:684–91.
Körfer R, El-Banayosy A, Arusoglu L, Minami K, Breymann T, Seifert D, Kizner L. Temporary pulsatile ventricular assist devices and biventricular assist devices. Ann Thorac Surg. 1999;68:678–83.
Hoy FB, Mueller DK, Geiss DM, Munns JR, Bond LM, Linett CE, Gomez RC. Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps? Ann Thorac Surg. 2000;70:1259–63.
Potapov EV, Loforte A, Weng Y, Jurmann M, Pasic M, Drews T, Loebe M, Hennig E, Krabatsch T, Koster A, Lehmkuhl HB, Hetzer R. Experience with over 1000 implanted ventricular assist devices. J Card Surg. 2008;23:185–94.
Hsu PS, Chen JL, Hong GJ, Tsai YT, Lin CY, Lee CY, Chen YG, Tsai CS. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg. 2010;37:328–33.
Elsharkawy HA, Li L, Esa WA, Sessler DI, Bashour CA. Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery. J Cardiothorac Vasc Anesth. 2010;24:946.
Wu MY, Lin PJ, Lee MY, et al. Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: treatment strategies and predictors of short-term and midterm survival. Resuscitation. 2010;81:1111.
Loforte A, Pilato E, Martin Suarez S, Folesani G, Jafrancesco G, Castrovinci S, et al. RotaFlow and CentriMag extracorporeal membrane oxygenation support systems as treatment strategies for refractory cardiogenic shock. J Card Surg. 2015;30:201–8.
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Fukuhara, S., Takeda, K., Garan, A.R. et al. Contemporary mechanical circulatory support therapy for postcardiotomy shock. Gen Thorac Cardiovasc Surg 64, 183–191 (2016). https://doi.org/10.1007/s11748-016-0625-4
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DOI: https://doi.org/10.1007/s11748-016-0625-4