Thorac Cardiovasc Surg 2012; 60 - PP127
DOI: 10.1055/s-0031-1297774

Postoperative ICU care of patients suffering from cardiogenic shock at time of left ventricular device placement

L Maroto Perez 1, A Stepanenko 2, N Dranishnikov 2, T Chavez 2, J Vierecke 2, EV Potapov 2, T Krabatsch 2, E Fulquet 1, R Hetzer 2
  • 1Hospital Clinico Universario de Valladolid, Department of Cardiovascular Surgery, Valladolid, Spain
  • 2Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

Aims: Cardiogenic shock at time of left ventricular assist device (LVAD) placement for treatment of terminal heart failure is related to high incidence of biventricular failure and its sequellae. We studied the catecholamine therapy and ICU complication profile of this specific patient cohort.

Methods: Between 08/2009 and 07/2011 a total of 21 patients suffering by cardiogenic shock were treated with the centrifugal blood pump HeartWare HVAD. All of them were preoperatively in INTERMACS level 1; 3 were supported with ECMO. Median age was 52 (range 32–70) years, 4 of them female; 52% had dilative cardiomyopathy and 38% idiopathic cardiomyopathy.

Results: Eight-six percent of patients survived to discharge with median length of ICU stay of 15 (range 6–101) days. Right ventricular protection therapy included: inhaled nitric oxide in 95%, adrenalin in 86%, milrinon in 67% patients with median therapy duration of 29 (range, 7–137) hours, 116 (range, 3–351) hours and 43 (range, 12–175) hours, respectively. Ventilation duration was 6 (range 1–32) days. In 5 patients temporary RVAD was required (3 bridged to permanent RVAD, one weaned and one died on RVAD). Three patients died in the ICU due to sepsis and multiorgan failure on the 6th, 13th and 22nd postoperative days. Median support duration is 229 (range, 6–665) days, with 14 patients with ongoing support and 2 being bridged to transplantation.

Conclusion: LVAD therapy in the case of onset of cardiogenic shock is a life-saving procedure with good long-term survival outcomes. These patients are at higher risk for RV failure. Therefore protection against it and aggressive prophylactic treatment may be of greater value than in patients without shock.