Experience with Magnetically-Levitated Centrifugal Flow Pump in Patients with Cardiogenic Shock (INTERMACS 1)

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Abstract

Introduction. Short term use of magnetically-levitated ventricular assist devices offers hemodynamic stabilization of patients with refractory cardiogenic shock in INTERMACS stage 1, enabling a therapeutic strategy.

Objective. The aim of this study was to assess in a single centre the results with second generation centrifugal flow pumps in
patients with refractory cardiogenic shock.

Methods. Fifteen patients with Levitronix CentriMag ventricular assist device implantation were retrospectively analyzed from
2006 to 2011. All patients presented refractory cardiogenic shock under two inotropic agents and 13 patients were also assisted with intra aortic balloon pump. The indications were: end stage cardiomyopathy in 8 patients, viral myocarditis in 1 patient, postpartum cardiomyopathy in 1 patient, postcardiotomy cardiogenic shock in 3 patients and post heart transplantation graft failure in 2 patients.

Results. Mean age was 49 ± 13 years, and 66% (10/15) were men. Only 1 patient underwent left ventricular assist device implantation (LVA) and 14 patients underwent biventricular assistance (BVA). Mean support duration was 6 ± 4 days (2-19). Final post-implant therapeutic decision was bridge to heart transplantation in 12 patients (80%), bridge to recovery in 1 patient (7%) and bridge to decision in 2 patients (13%). One patient was successfully weaned from BVA due to ventricular function recovery and 8 patients were transplanted, with a survival rate of 60% (9/15). Reoperation due to bleeding was performed in 6 patients (40%) and 1 patient presented cannulae thrombosis. None of the patients had stroke or technical system failures. Six patients died while receiving circulatory assistance (40%) (5 BVA and 1 LVA), 1 patient due to sepsis, 1 patient due to coagulopathy and 4 patients due to multiple system organ failure. Out of the 6 deaths, 2 patients were in postcardiotomy cardiogenic shock and 4 were on heart transplantation waiting list.

Conclusions. In this series, circulatory support with Levitronix CentriMag centrifugal flow pump was effective in critical patients with a survival rate of 60%. Reoperation for bleeding was the most frequent complication.