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Open Journal of Cardiovascular Surgery

Single Center Experience with Short-term Circulatory Support: A Comparison of Demography, Indication and Clinical Outcome Over the Past Decade

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Open Journal of Cardiovascular Surgery 2010:3 17-25

Original Research

Published on 15 Oct 2010

DOI: 10.4137/OJCS.S5396


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Abstract

Objective: Aim of the study was to analyze changes over a ten years observation period regarding demography, indication for support and clinical outcome in patients treated with short-term mechanical circulatory support (MCS) for cardiogenic failure.

Methods: 39 patients treated with MCS between 2006–2008 (2008 group) were analyzed, assessing demography, complication rates and survival. Results were compared with 36 consecutive patients that had received centrifugal MCS between 1996–1998 (1998 group) at our institution.

Results: Mean age was 59.9 ± 12.9 (1998 group) and 60.9 ± 13.9 years (P = 0.74). Mean logEuroScores rose from 12.0% ± 14.6% (1998 group) to 26.9% ± 20.5% (2008 group); P , 0.001. Postcardiotomy low output syndrome was the main cause for MCS. However the percentage of patients in cardiogenic shock prior to surgery increased from 19.4% (1998 group) to 33.3% (2008 group); P = 0.17.

Complexity and urgency of the primary surgical procedure increased significantly. 16.7% (1998 group) vs. 41.0% (2008 group); P = 0.02 of interventions were classified “salvage/emergent”. Mean duration of support was 2.9 ± 1.9 days (1998 group) and 3.8 ± 3.1 days (2008 group); P = 0.14. Significantly more biventricular support was implemented in the 2008 group (23.1% vs. 5.6% in the 1998 group); P = 0.03. The incidence of complications, including device failure, thromboembolism and infection remained the same in both groups. 63.9% (1998 group) and 61.5% (2008 group) of the patients were successfully weaned from the device (P = 0.83), 12% (1998 group) and 3% (2008 group) of the VAD patients were bridged to long-term VAD (P = 0.12). Overall 30-day survival rates were similar (22.2% 1998 group vs. 28.2%; 2008 group); P = 0.55, however, survival rate in BVAD supported patients improved significantly.

Conclusion: These data demonstrate the beneficial effect of MCS to salvage patients with cardiac failure. Taking into consideration that the severity of illness, the complexity and urgency of the primary surgical procedure have steadily increased a comparable improvement in MCS outcome over the past decade was observed. Nevertheless, in-hospital mortality and VAD related complication rates such as bleeding remain high.



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