Skip to main content

Advertisement

Log in

Contemporary mechanical circulatory support therapy for postcardiotomy shock

  • Current Topics Review Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    CAS  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Curtis JJ, McKenney-Knox CA, Wagner-Mann CC. Postcardiotomy centrifugal assist: a single surgeon’s experience. Artif Organs. 2002;26:994–7.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sylvin EA, Stern DR, Goldstein DJ. Mechanical support for postcardiotomy cardiogenic shock: has progress been made? J Card Surg. 2010;25:442–54.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Magovern GJ, Simpson KA. Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg. 1999;68:655–61.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. Smedira NG, Blackstone EH. Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg. 2001;71(3 Suppl):S82–5, S60–6.

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  CAS  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. Park SC, Neches WH, Mullins CE, Girod DA, Olley PM, Falkowski G, et al. Blade atrial septostomy: collaborative study. Circulation. 1982;66:258–66.

    Article  CAS  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. Cheng A, Swartz MF, Massey HT. Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation. ASAIO J. 2013;59:533–6.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. Goldstein DJ, Oz MC. Mechanical support for postcardiotomy cardiogenic shock. Semin Thorac Cardiovasc Surg. 2000;12:220–8.

    Article  CAS  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  CAS  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  CAS  PubMed  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. 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.

    PubMed  PubMed Central  Google Scholar 

  45. 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.

    PubMed  PubMed Central  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

    Article  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. 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.

    Article  CAS  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  53. 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.

    Article  CAS  PubMed  Google Scholar 

  54. 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.

    Article  CAS  PubMed  Google Scholar 

  55. Wang SS, Chen YS, Ko WJ, Chu SH. Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock. Artif Organs. 1996;20:1287–91.

    Article  CAS  PubMed  Google Scholar 

  56. 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.

    Article  CAS  PubMed  Google Scholar 

  57. 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.

    Article  PubMed  Google Scholar 

  58. 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.

    Article  CAS  PubMed  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. 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.

    PubMed  Google Scholar 

  61. 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.

    Article  PubMed  Google Scholar 

  62. 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.

    Article  PubMed  Google Scholar 

  63. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shinichi Fukuhara.

Ethics declarations

Conflict of interest

None.

Additional information

This review was submitted at the invitation of the editorial committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-016-0625-4

Keywords

Navigation