Minimally invasive CentriMag ventricular assist device support integrated with extracorporeal membrane oxygenation in cardiogenic shock patients: a comparison with conventional CentriMag biventricular support configuration
Koji Takeda,Arthur R. Garan,Masahiko Ando,Jiho Han,Veli K. Topkara,Paul Kurlansky,Melana Yuzefpolskaya,Maryjane Farr,Paolo C. Colombo,Yoshifumi Naka,Hiroo Takayama +10 more
TL;DR: Ec-VAD is a unique approach for the treatment of patients in cardiogenic shock that eliminates the need for cardiopulmonary bypass and reduces blood product utilization and bleeding events.
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Abstract: OBJECTIVES We recently developed a novel minimally invasive surgical approach that combines extracorporeal membrane oxygenation and CentriMag ventricular assist device (Ec-VAD) for the treatment of cardiogenic shock as a short-term circulatory support. We compared the outcomes of this new approach to conventional CentriMag biventricular assist device (BiVAD) support through a median sternotomy. METHODS Between July 2015 and August 2016, 22 patients were implanted with CentriMag Ec-VAD and 90 patients were implanted with conventional CentriMag BiVAD. The Ec-VAD circuit was configured with left ventricular apical cannulation via a mini-thoracotomy and femoral venous cannulation as inflows and right axillary artery cannulation as an outflow. RESULTS Patients with Ec-VAD were older (58 ± 9.9 vs 53 ± 13 years, P = 0.06), had more preoperative percutaneous mechanical circulatory support use (82% vs 44%, P < 0.01) and less cardiopulmonary bypass use intraoperatively (0% vs 66%, P < 0.01). Patients who received Ec-VAD required less transfusions. The Ec-VAD group had a significantly lower incidence of major bleeding events during support (32% vs 72%, P < 0.01). Average systemic flow was similar (Ec-VAD: 5.5 ± 0.94 vs BiVAD: 5.7 ± 1.1 l/min, P = 0.4). Seventeen patients (77%) with Ec-VAD survived to the next destination compared with 66 patients (73%) with BiVAD (P = 0.45). Thirty-day survival was similar between groups (Ec-VAD 86% vs BiVAD 76%, P = 0.39), and overall 1-year survival was 61% in Ec-VAD and 55% in BiVAD (P = 0.7). CONCLUSIONS Ec-VAD is a unique approach for the treatment of patients in cardiogenic shock. It eliminates the need for cardiopulmonary bypass and reduces blood product utilization and bleeding events.
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Citations
Comparison of temporary ventricular assist devices and extracorporeal life support in post-cardiotomy cardiogenic shock.
Prashant N. Mohite,Anton Sabashnikov,Achim Koch,Raj Binu,Ashok Padukone,Sundip Kaul,Olaf Maunz,Diana Garcia-Saez,Bartlomiej Zych,Mubassher Husain,Fabio De Robertis,Aron-Frederik Popov,Andre R. Simon +12 more
TL;DR: VAD and ECMO represent essential tools to support patients with PCCS and preliminary results might indicate some benefits of using VAD in this group of patients; however, this evidence should be further assessed in larger multicentre trials.
Use of oxygenator with short‐term ventricular assist devices
Prashant N. Mohite,Rita Fernandez Garda,Kabeer Umakumar,Sundip Kaul,Nandor Marczin,Bartlomiej Zych,Diana Garcia-Saez,Maria Monteagudo-Vela,Balakrishnan Mahesh,Ulrich Stock,Fabio De Robertis,Andre R. Simon +11 more
TL;DR: Oxy-VAD proves a viable, and probably, a better option to VA-ECMO in acute cardiorespiratory decompensation and offers organ-specific tailor-made support to the right and/ or left heart and/or lungs.
6
When NOT to use short term mechanical circulatory support
Vivek Rao,Fillio Billia +1 more
- 09 Aug 2020
5
Post-Cardiotomy Shock Syndrome- A Narrative Review of Perioperative Diagnosis and Management.
Andrea Corujo-Rodriguez,Ellen Richter,Stephanie O. Ibekwe,Tina Shah,Abimbola O Faloye +4 more
TL;DR: The epidemiology and pathophysiology of PCS is discussed, the rationale and evidence behind the initiation, continuation, escalation, and discontinuation of mechanical support devices in PCS, and the anesthetic implications are discussed.
4
Financial implications of using extracorporeal membrane oxygenation following heart transplantation.
Bhuvaneswari Krishnamoorthy,V. Mehta,William R. Critchley,Paul Callan,Steve Shaw,Rajamiyer Venkateswaran +5 more
TL;DR: Patients with primary graft dysfunction following heart transplantation who require ECMO are frequently bridged to a recovery; however, the medium and longer-term survival for these patients is poorer than for patients who do not requireECMO.
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Bridge-to-Decision Therapy With a Continuous-Flow External Ventricular Assist Device in Refractory Cardiogenic Shock of Various Causes
Hiroo Takayama,Lori Soni,Bindu Kalesan,Lauren K. Truby,Takeyoshi Ota,S.R. Cedola,Zain Khalpey,Nir Uriel,Paolo C. Colombo,Donna M. Mancini,Ulrich P. Jorde,Yoshifumi Naka +11 more
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