COMPARATIVE STUDY
JOURNAL ARTICLE

Use of the percutaneous left ventricular assist device in patients with severe refractory cardiogenic shock as a bridge to long-term left ventricular assist device implantation

Gary M Idelchik, Leo Simpson, Andrew B Civitello, Pranav Loyalka, Igor D Gregoric, Reynolds Delgado, Biswajit Kar
Journal of Heart and Lung Transplantation 2008, 27 (1): 106-11
18187095

BACKGROUND: For patients with persistent cardiogenic shock refractory to intraaortic balloon pump (IABP) support, there are only limited means of resuscitation and bridging to surgical left ventricular assist device (LVAD) implantation. Extracorporeal membrane oxygenation and emergency surgical approaches have been attempted but are associated with significant morbidity and mortality. We evaluated the efficacy of a percutaneous left ventricular assist device (PVAD) as a bridge to LVAD implantation in patients in cardiogenic shock refractory to IABP and pressor support.

METHODS: Between May 2003 and April 2006, at our institution, 18 patients in severe refractory cardiogenic shock received a PVAD as a bridge to LVAD placement or orthotopic heart transplantation. Six patients had ischemic cardiomyopathy, and 12 had nonischemic cardiomyopathy. At the time of PVAD placement, 17 were receiving IABP support, and 10 were undergoing cardiopulmonary resuscitation.

RESULTS: The mean duration of PVAD support was 4.2 +/- 2.5 days. During this time, the cardiac index improved from 0.86 +/- 0.66 to 2.50 +/- 0.93 liters/min/m2 (p < 0.001), systolic blood pressure improved from 72 +/- 11 to 98 +/- 15 mm Hg (p = 0.001), and systemic mixed venous oxygenation improved from 37 +/- 7 to 62 +/- 6 mm Hg (p < 0.001). We terminated life support in 4 of the 18 patients before LVAD placement; 14 were successfully bridged to LVAD or heart transplantation. The mortality rate was 27% at 30 days and 33% at 6 months. There were no PVAD-associated deaths.

CONCLUSION: In patients with terminal hemodynamic collapse, PVAD support is an effective bridging therapy to LVAD and appears to be a viable alternative to other invasive methods of support.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
18187095
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"