Objective

The outcome of patients presenting with cardiogenic shock remains poor due to a combination of biventricular failure and end organ dysfunction. Durable mechanical support including include LVAD +- RVAD or Total Artificial Heart may not be appropriate in such patients but short term bridging using either VA ECMO or Levitronix centrimag may be reasonable. Since 2014 we have opted to use the latter in all but the sickest of patients. The aim of this study was to examine our clinical outcomes.

Methods

In a two year period 12 consecutive patients underwent short term bridging using Levitronix centrimag utilising a biventricular circuit including drainage from the LV apex. In 4 patients this was done without bypass, a further 3 from ECMO and of the remainder 2 required CPR onto bypass. Prospectively collected data on all implants was collated and the results presented.

Results

3 patients were converted from ECMO and 1 from an Impella as an emergency following catastrophic device failure. 5 patients had an ischemic cardiomyopathy, 2 with an inferior VSD. 4 patients had DCM, 2 myocarditis and 1 Amyloid. 2 patients recovered and one patient died early. The remainder were listed for transplantation. 3 died on support, 5 were successfully transplanted. Overall 7/11 (64%) survived to either recovery or transplantation. One patient remains on support and urgently listed.

Conclusion

Levitronix BIVADS are becoming an established means of bridging patients with cardiogenic shock. The introduction of the proposed super-urgent heart transplant list may further improve such results.