Bridging patients in cardiogenic shock with a paracorporeal pulsatile biventricular assist device to heart transplantation-a single-centre experience.

Autor:	Michel S; Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany.; Division of Congenital Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Buchholz S; MediClin Heart Center, Lahr, Germany., Buech J; Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Veit T; Department of Pulmonology, Ludwig Maximilian University Munich, Munich, Germany., Fabry T; Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Abicht J; Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany., Thierfelder N; Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Mueller C; Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Rosenthal LL; Division of Congenital Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Pabst von Ohain J; Division of Congenital Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Haas N; Department of Pediatric Cardiology, Ludwig Maximilian University Munich, Munich, Germany., Hörer J; Division of Congenital Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany., Hagl C; Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany.; Munich Heart Alliance, German Centre for Cardiovascular Research, Germany.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2022 Mar 24; Vol. 61 (4), pp. 942-949.
DOI:	10.1093/ejcts/ezab547
Abstrakt:	Objectives: We evaluated the outcome of patients in cardiogenic shock receiving a paracorporeal pulsatile biventricular assist device as a bridge to transplantation. Methods: We performed a retrospective single-centre analysis of all patients who received a Berlin Heart Excor® at our institution between 2004 and 2019. Results: A total of 97 patients (90 adults, 7 paediatric) were analysed. Eighty-four patients were in Interagency Registry for Mechanically Assisted Circulatory Support level 1 (80 adults, 4 paediatric). Diagnoses were dilated cardiomyopathy (n = 41), ischaemic cardiomyopathy (n = 17) or myocardial infarction (n = 4), myocarditis (n = 15), restrictive cardiomyopathy (n = 2), graft failure after heart transplant (n = 7), postcardiotomy heart failure (n = 5), postpartum cardiomyopathy (n = 3), congenital heart disease (n = 1), valvular cardiomyopathy (n = 1) and toxic cardiomyopathy (n = 1). All patients were in biventricular heart failure and had secondary organ dysfunction. The mean duration of support was 63 days (0-487 days). There was a significant decrease in creatinine values after assist device implantation (from 1.83 ± 0.79 to 1.12 ± 0.67 mg/dl, P = 0.001) as well as a decrease in bilirubin values (from 3.94 ± 4.58 to 2.65 ± 3.61 mg/dl, P = 0.084). Cerebral stroke occurred in 16 patients, bleeding in 15 and infection in 13 patients. Forty-eight patients died on support, while 49 patients could be successfully bridged to transplantation. Thirty-day survival and 1-year survival were 70.1% and 41.2%, respectively. Conclusions: A pulsatile biventricular assist device is a reasonable therapeutic option in cardiogenic shock, when immediate high cardiac output is necessary to rescue the already impaired kidney and liver function of the patient. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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