Strategies for Management of Postcardiotomy Cardiogenic Shock following Valvular Heart Surgery

2004 ◽  
pp. 140-149 ◽  
Author(s):  
D.W. Vigilance ◽  
M.C. Oz
Keyword(s):  
Cardiogenic Shock ◽  
Heart Surgery ◽  
Postcardiotomy Cardiogenic Shock

scholarly journals The impact of Centre’s heart transplant status and volume on in-hospital outcomes following extracorporeal membrane oxygenation for refractory post-cardiotomy cardiogenic shock: a meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mariusz Kowalewski ◽  
Giuseppe Maria Raffa ◽  
Kamil Zieliński ◽  
Musab Alanazi ◽  
Martijn Gilbers ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Heart Transplantation ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Neurological Complications ◽  
Congenital Heart Surgery ◽  
Apparent Difference ◽  
Postcardiotomy Cardiogenic Shock ◽  
The Impact

Abstract Background Postcardiotomy cardiogenic shock (PCS) that is refractory to inotropic support remains a major concern in cardiac surgery and is almost universally fatal unless treated with mechanical support. While reported mortality rates on ECMO vary from center to center, aim of the current report is assess if the outcomes differ between centres according to volume and heart transplantation status. Methods A systematic search was performed according to PRISMA statement using PubMed/Medline databases between 2010 and 2018. Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and heart transplantation status of the centre. Paediatric and congenital heart surgery-related studies along with those conducted in the setting of veno-venous ECMO for respiratory distress syndrome were excluded. Differences were assessed by means of subgroup meta-analysis and meta-regression. Results Fifty-four studies enrolling N = 4421 ECMO patients were included. Of those, 6 series were performed in non-HTx centres (204 pts.;4.6%). Overall 30-day survival (95% Confidence Intervals) was 35.3% (32.5–38.2%) and did not statistically differ between non-HTx: 33.3% (26.8–40.4%) and HTx centres: 35.7% (32.7–38.8%); Pinteraction = 0.531. There was no impact of centre volume on survival as well: ßcoef = 0.0006; P = 0.833. No statistical differences were seen between HTx and non-HTx with respect to ECMO duration, limb complications, reoperations for bleeding, kidney injury and sepsis. There were however significantly less neurological complications in the HTx as compared to non-HTx centres: 11.9% vs 19.5% respectively; P = 0.009; an inverse relationship was seen for neurologic complications in centres performing more ECMOs annually ßcoef = − 0.0066; P = 0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx facilities. Conclusions There was no apparent difference in survival after ECMO implantation for refractory PCS according to centre’s ECMO volume and transplantation status. Potentially different risk profiles of patients in these centres must be taken account for before definite conclusions are drawn.

scholarly journals Intra-aortic balloon assist for postcardiotomy cardiogenic shock

1973 ◽  
Vol 66 (6) ◽  
pp. 906-915 ◽  
Author(s):  
Robert L. Berger ◽  
Virender K. Saini ◽  
Thomas J. Ryan ◽  
David M. Sokol ◽  
John F. Keefe
Keyword(s):  
Cardiogenic Shock ◽  
Postcardiotomy Cardiogenic Shock

Mechanical circulatory support with the Impella 5.0 and the Impella Left Direct pumps for postcardiotomy cardiogenic shock at La Pitié-Salpêtrière Hospital

2019 ◽  
Vol 57 (1) ◽  
pp. 183-188 ◽  
Author(s):  
Charles-Henri David ◽  
Astrid Quessard ◽  
Ciro Mastroianni ◽  
Guillaume Hekimian ◽  
Julien Amour ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Heart Function ◽  
Left Ventricular ◽  
Survival Outcome ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
The Mean ◽  
Postcardiotomy Cardiogenic Shock

Abstract OBJECTIVES Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates of 50–80%. Although veno-arterial extracorporeal membrane oxygenation has been used as mechanical circulatory support in patients with PCCS, it is associated with a high rate of complications and poor quality of life. The Impella 5.0 and Impella Left Direct (LD) (Impella 5.0/LD) are minimally invasive left ventricular assist devices that provide effective haemodynamic support resulting in left ventricular unloading and systemic perfusion. Our goal was to describe the outcome of patients with PCCS supported with the Impella 5.0/LD at La Pitié-Salpêtrière Hospital. METHODS We retrospectively reviewed consecutive patients supported with the Impella 5.0/LD for PCCS between December 2010 and June 2015. Survival outcome and in-hospital complications were assessed. RESULTS A total of 29 patients (63 ± 14 years, 17% women) with PCCS were supported with the Impella 5.0/LD. At baseline, 69% experienced chronic heart failure, 66% had dilated cardiomyopathy and 57% had valvular disease. The mean EuroSCORE II was 22 ± 17 and the ejection fraction was 28 ± 11%. Most of the patients underwent isolated valve surgery (45%) or isolated coronary artery bypass grafting (38%). The mean duration of Impella support was 9 ± 7 days. Weaning from the Impella was successful in 72.4%, and 58.6% survived to discharge. Recovery of native heart function was observed in 100% of discharged patients. Survival to 30 days and to 1 year from Impella implant was 58.6% and 51.7%, respectively. CONCLUSIONS The Impella 5.0 and the Impella LD represent an excellent treatment option for critically ill patients with PCCS and are associated with favourable survival outcome and native heart recovery.

Concomitant ECMO And IABP Support in Postcardiotomy Cardiogenic Shock Patients

2021 ◽  
Author(s):  
Ilija Djordjevic ◽  
Antje-Christin Deppe ◽  
Anton Sabashnikov ◽  
Elmar Kuhn ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Iabp Support ◽  
Postcardiotomy Cardiogenic Shock

Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

Perfusion ◽  
2021 ◽  
pp. 026765912110066
Author(s):  
Xiaochen Ding ◽  
Haixiu Xie ◽  
Feng Yang ◽  
Liangshan Wang ◽  
Xiaotong Hou
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Sofa Score ◽  
Adult Patients ◽  
Left Ventricular Ejection ◽  
Survival Group ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Postcardiotomy Cardiogenic Shock

Background: The suitability of model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict the incidence of acute kidney injury (AKI) and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock (PCS) requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) remains uncertain. This study was performed to explore whether the MELD-XI score has the association with the incidence of AKI and in-hospital mortality in these patients. Methods: Adult patients with PCS requiring VA ECMO from January 2012 to December 2017 were enrolled and first classified into AKI group ( n = 151) versus no-AKI group ( n = 132), then classified into survival group ( n = 143) versus no-survival group ( n = 140). Multivariate logistic regressions were performed to identify factors independently associated with AKI and mortality. Baseline data were defined as the first measurement available. Results: Of 283 patients, the incidence of AKI was 53.36%. The in-hospital mortality rates were 63.58% and 33.33% in patients with and without AKI (p < 0.0001). Baseline MELD-XI score, baseline serum total bilirubin (T-Bil), baseline blood urea nitrogen (BUN), baseline left ventricular ejection fraction (LVEF), sequential organ failure assessment (SOFA) score, and lactate level at ECMO initiation were shown to be associated with the AKI. Vasoactive-inotropic score (VIS) and SOFA score at ECMO initiation as well as renal failure requiring renal replacement therapy (RRT) were shown to be associated with in-hospital mortality. Conclusions: The baseline MELD-XI score, baseline BUN, baseline T-Bil, baseline LVEF, SOFA score and lactate at the initiation of ECMO were associated with AKI. AKI, SOFA score, and VIS at the initiation of ECMO were associated with in-hospital mortality, whereas MELD-XI score was not found to be associated with in-hospital mortality. A specific MELD-XI score as a threshold, as well as its sensitivity and specificity, needs to be confirmed in further studies.

Efficacy of Phosphodiesterase Inhibitor Enoximone in Management of Postcardiotomy Cardiogenic Shock

1992 ◽  
Vol 26 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Stein Iversen ◽  
Eckhard Mayer ◽  
Ulrich Hake ◽  
Walther Schmiedt ◽  
Heinz Jakob ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Phosphodiesterase Inhibitor ◽  
Postcardiotomy Cardiogenic Shock
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