- Oral presentation
- Open Access
Thoratec Centrimag VAD for cardiogenic shock – a developing country experience
© Villavicencio et al; licensee BioMed Central Ltd. 2013
- Published: 11 September 2013
- Cardiogenic Shock
- NYHA Class
- Multiorgan Failure
- Circulatory Support
- Support Time
Circulatory support is usually not available in developing countries due to cost restrictions. Long-term devices are almost always not affordable for our health system and Thoratec Centrimag® may be an alternative. We report our experience in the treatment of cardiogenic shock with this intermediate-term device.
Thoratec Centrimag® was used in 22 cardiogenic shock patients. All were INTERMACS class I and all but one had multiorgan failure. Seventeen (77%) were male, mean age 41+13 years. Etiology was ischemic in 11(50%), dilated in 4(22%), and other etiology in 7(32%). Nine (41%) had previous cardiac arrest with a mean arrest time of 18+16 min. Circulatory support was biventricular in 18(82%), univentricular 4(18%), and in 6(27%) an oxygenator was interposed within the outflow line until respiratory recovery. Patients with veno-arterial ECMO configurations were excluded.
Bridge-to-transplant or recovery was obtained in 14 out of 22 (64%). Mean support time 44 days, range 1-292 days. Eight patients (36%) were supported for more than 4 weeks. Thirty-day post-implant survival was 73% (16 patients). Post-implant complications were re-exploration for bleeding 7(32%), neurologic dysfunction 3(14%), pneumonia 8(36%), and renal failure with dialysis in (32%). Eleven (50%) patients are in NYHA class I after a mean follow-up time of 32+6 months. Kaplan Meier one-year survival was 56+11%. Eleven out of 12 (92%) bridged-to-transplant are in NYHA functional class I with normal biventricular function. One patient died 3 days post-transplant due to inflammatory response. Two patients were bridged-to-recovery. One is in NYHA class I and the other died due to non-compliance.
Thoratec Centrimag® is useful to provide intermediate-term circulatory support for cardiogenic shock and multiorgan failure in a developing country. Support time longer than 4 weeks is feasible. A multidisciplinary approach is needed since morbidity is common.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.