Advanced mechanical circulatory support for post-cardiotomy cardiogenic shock: a 20-year outcome analysis in a non-transplant unit

Maziar Khorsandi; Kasra Shaikhrezai; Sai Prasad; Renzo Pessotto; William Walker; Geoffrey Berg; Vipin Zamvar

doi:10.1186/s13019-016-0430-2

Table 1 Illustrates patient characteristics, the type of mechanical circulatory support and outcomes over the 11-year study period

From: Advanced mechanical circulatory support for post-cardiotomy cardiogenic shock: a 20-year outcome analysis in a non-transplant unit

	Age & gender	Co-morbidities & logistic euroSCORE	Date of surgery	Original operation	Duration and mode of AMCS	AMCS complication/s	Outcome
Patient 1	76 year old male	MI	2012	Re-do sternotomy and AVR	Salvage peripheral VA ECMO due to postoperative pulmonary haemorrhage	Femoral artery cannulation site pseudoaneurysm	Alive
		CABG				Femoral artery cannulation site pseudoaneurysm	Alive
		Moderate LVSD				Major haemorrhage from cannulation site	NYHA I (No breathlessness of exertion, back to work)
		Hypertension
		Hypercholestrolaemia
		ICD for VF
		CVA
		EuroSCORE = 27.48
Patient 2	40 year old male	MV repair	2014	Re-do, Re-do sternotomy for type A aortic dissection: Bentall procedure.	Salvage RVAD due to VF arrest and asystolic LV after CPB	Major haemorrhage and re-exploration in the operating theatre	Alive
		MVR					Alive
		MVR					NYHA II (Breathless on exertion)
		Moderate LVSD
		Marfan’s syndrome
		AF
		LogEuroSCORE = 29.18
Patient 3	82 year old male	Severe LVSD	2006	MV Repair and CABG	3 Days	Could not be weaned from ECMO with severe biVent failure	Died in CTICU
		MI			VA ECMO as unable to wean from CPB		COD: BiVent failure
		Severe TVD
		LogEuroSCORE = 17.45
Patient 4	72 year old Female	Good LV function	2011	AVR	9 Days	Septic shock	Died in CTICU
		Moderate MR			VA ECMO as unable to come off CPB	Peripheral ischaemia	COD: Septic shock
		EuroSCORE = 12.11			VA ECMO as unable to come off CPB	Peripheral ischaemia	COD: Septic shock
Patient 5	71 year old male	Urgent/Emergency Surgery	2011	CABGx3 and AVR	2 Days	ECMO cannulation site bleeding and haematoma explored	Died in CTICU
		Urgent/Emergency Surgery			Peripheral VA ECMO as unable to come off CPB	Renal failure^a	COD: Shock (unknown cause)
		MI (< 90 days)
		Severe LVSD
		Severe TVD
		Anaemia
		LogEuroSCORE = 26.35
Patient 6	83 year old female	Urgent/Emergency Surgery	2012	MVR and CABG ×1	< 1 Day	None	Died in CTICU
		Urgent/Emergency Surgery			Peripheral VA ECMO as unable to come off bypass and awaited family to see patient last time		COD: BiVent failure
		MI (< 90 days)
		Severe LVSD
		Acute severe MR
		Cardiogenic shock
		LogEuroSCORE = 73.26
Patient 7	70 year old male	MI	2013	Re-do sternotomy and AVR	33 Days	Major CVA	Died in HDU
		CABG			VA ECMO. Successfully weaned from ECMO		COD: severe Respiratory failure
		CVA
		Hypertension
		Hypercholestrolaemia
		Good LV
		LogEuroSCORE = 14.31
Patient 8	72 year old male	Moderate LVSD	2013	Re-do sternotomy and AVR	< 1 Day	ECMO cannulation femoral artery dissection	Died in CTICU
		CABG			< 1 Day	ECMO cannulation femoral artery dissection	Died in CTICU
		Atrial flutter			VA ECMO after iatrogenic aortic dissection during Femoral cannulation for bypass	Major haemorrhage	COD: Major CVA
		Hypertension				Major haemorrhage
		LogEuroSCORE = 13.09				Major CVA
Patient 9	51 year old male	Moderate LVSD	2013	Re-suspension of Aortic valve and repair of type A aortic dissection	1 Day	Major cannulation site haemorrhage	Died in CTICU
Patient 9	51 year old male	LogEuroSCORE = 13.13	2013		Peripheral VA ECMO	Major cannulation site haemorrhage	COD: Haemorrahgic shock and BiVent failure
Patient 10	34 year old female	Good LV	2014	IVC Leiomyosarcoma resection	3 Days	None	Died in CTICU
Patient 10	34 year old female	LogEuroSCORE = 2.08	2014	IVC Leiomyosarcoma resection	VA ECMO	None	COD: BiVent failure from acute MI
Patient 11	65 year old male	Urgent surgery	2013	CABG	2 Days	Renal failure^a	Died in CTICU
		ACS (Unstable angina)			Salvage VA ECMO	Hepatic failure	COD: MODS
		LogEuroSCORE = 4.55			Salvage VA ECMO	Pulmonary oedema	COD: MODS
Patient 12	71 year old male	Peripheral vasculopath	2015	CABG	3 Days	Major haemorrhage: Re-opening for bleeding ×4	Died in CTICU
		LogEuroSCORE = 3.67			3 Days	Major haemorrhage: Re-opening for bleeding ×4	Died in CTICU
		LogEuroSCORE = 3.67			VA ECMO as unable to wean from CPB	Peripheral leg ischaemia	COD: biventricular failure and septic shock
Patient 13	49 year old male	Emergency Surgery	1997	CABG	VA ECMO	Note recorded	Alive (Died 2004) NYHA II
		PVD
		Intra-operative MI
		LogEuroSCORE = 5.69
Patient 14	69 year old male	Active IE	2004	MVR and CABG for mitral valve IE	VA ECMO	CVA and seizures Renal failure^a	Alive NYHA II
		Emergency surgery
		Moderate LVSD
		LogEuroSCORE = 21.73
Patient 15	41 year old female	Emergency surgery	2005	Aortic transection and diaphragmatic rupture	VA ECMO	Not recorded	Alive NYHA I
		Good LV
		LogEuroSCORE = 25.50
Patient 16	59 year old male	MI (< 90 days)	2006	Type A aortic dissection	2 Days	Not recorded	Died COD: Bivent failure
		Severe LVSD			Peripheral VA ECMO as unable to come off bypass
		Emergency surgery
		LogEuroSCORE = 33.90

Abbreviations: ACS acute coronary syndrome, AF atrial fibrillation, AMCS advanced mechanical circulatory support, AVR aortic valve replacement, CABG coronary artery bypass grafting surgery, CPB cardiopulmonary bypass, COD cause of death, BiVent failure biventricular failure, MVR mitral valve replacement, IE infective endocarditis, CVA cerebrovascular accident, IVC, inferior vena-cava, NYHA New York Heart Association, CTICU cardiothoracic intensive care unit, HDU high dependency unit, implantable cardioverter defibrillator, MI myocardial infarction, LVSD left ventricular systolic dysfunction, TVD triple vessel coronary artery disease, LV left ventricular, MR mitral regurgitation, PVD peripheral vascular disease, MODS multi-organ dysfunction syndrome, VF ventricular fibrillation, VAD ventricular assist device, VA veno-arterial;
^aAll patients with renal failure required renal replacement therapy

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