Hiroo Takayama1, Koji Takeda, Darshan Doshi, Ulrich P Jorde. 1. aDivision of Cardiothoracic Surgery bDivision of Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
Abstract
PURPOSE OF REVIEW: To provide a comprehensive update on the current state of short-term, continuous-flow ventricular assist devices (CF-VADs) in the treatment of refractory cardiogenic shock in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients. RECENT FINDINGS: The mortality rate associated with refractory cardiogenic shock remains markedly elevated, with INTERMACS 1 profile repeatedly demonstrating the worst outcomes. Recent innovations in continuous-flow pump technology have not only contributed to improved outcomes with long-term left ventricular assist device technology, but have also led to the development of various short-term, percutaneous, and surgical CF-VADs. Short-term CF-VADs have several favorable features, but, most notably, they allow the effective temporary stabilization of otherwise refractory cardiogenic shock and serve as a bridge-to-decision therapy. SUMMARY: Clinical evidence supporting the use of CF-VADs still remains at the level of small case series, but the data appear promising. However, further rigorous clinical investigation is necessary in order to prove the overall clinical efficacy of these devices in refractory cardiogenic shock.
PURPOSE OF REVIEW: To provide a comprehensive update on the current state of short-term, continuous-flow ventricular assist devices (CF-VADs) in the treatment of refractory cardiogenic shock in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients. RECENT FINDINGS: The mortality rate associated with refractory cardiogenic shock remains markedly elevated, with INTERMACS 1 profile repeatedly demonstrating the worst outcomes. Recent innovations in continuous-flow pump technology have not only contributed to improved outcomes with long-term left ventricular assist device technology, but have also led to the development of various short-term, percutaneous, and surgical CF-VADs. Short-term CF-VADs have several favorable features, but, most notably, they allow the effective temporary stabilization of otherwise refractory cardiogenic shock and serve as a bridge-to-decision therapy. SUMMARY: Clinical evidence supporting the use of CF-VADs still remains at the level of small case series, but the data appear promising. However, further rigorous clinical investigation is necessary in order to prove the overall clinical efficacy of these devices in refractory cardiogenic shock.
Authors: Michael M Koerner; Michael D Harper; Christopher K Gordon; Douglas Horstmanshof; James W Long; Michael J Sasevich; James D Neel; Aly El Banayosy Journal: Ann Cardiothorac Surg Date: 2019-01