Survival on biventricular mechanical support with the Centrimag® as a bridge to decision: a single-center risk stratification.

OBJECTIVE: Temporary mechanical assist devices are increasingly being used as a lifesaving bridge to decision in patients requiring cardiopulmonary resuscitation. We report our single-center experience with biventricular Centrimag® pumps over a five-year period. METHOD: Data was retrospectively collected in consecutive patients who required biventricular support from 2008 to 2013. Patients who were supported with central cannulation using the Centrimag® system were analyzed. In addition to demographic information, data pertaining to indications, outcomes and mortality were collected. RESULTS: The cohort consisted of 48 patients (19 women and 29 men, mean age of 56 years). The median duration of support was 14 days. The median duration to patient expiration while still on the Centrimag® was 12 days. Thirty-day survival was 56% (27/48). Nine patients were explanted to recovery, while fourteen patients were converted to a durable LVAD, two of whom were then transplanted. We stratified patients into two groups. Group I comprised patients who were either explanted to recovery, converted to durable LVAD or transplanted (23/48) and Group II consisted of patients who either died on the Centrimag® or were explanted for withdrawal of care (25/48). Statistical analysis did not reveal any clinically significant differences between the two groups in terms of age, sex, etiology, hemodynamic, co-morbidities or laboratory parameters. CONCLUSION: The biventricular Centrimag® can be used as a bridge to decision in patients with thirty-day survival of >50%. Parameters to predict 30-day survival in this high-risk cohort continue to remain elusive.

Use of a single circuit to provide temporary mechanical respiratory and circulatory support in patients with LV apical thrombus and cardiogenic shock.

INTRODUCTION: Techniques to support patients with cardiogenic shock continue to improve. Patients with intracardiac thrombi pose a potential for additional complications. Novel methods of biventricular support are necessary to manage these patients. METHODS: Two patients with refractory cardiogenic shock and left ventricular apical thrombi underwent mechanical circulatory support (MCS) as a bridge to decision, with a left ventricular assist device (LVAD) and extracorporeal mechanical oxygenation (ECMO). Instead of the conventional LV apical cannulation for LVAD, the left atrium (LA) was cannulated. The LA cannula was then integrated with the ECMO circuit via a 'Y' connection to a percutaneous right atrial cannula, enabling optimal drainage of both sides into one circuit through a single CentriMag® pump and ECMO into the aorta. RESULTS: The first patient was converted to a durable LVAD and transplanted, while the second patient was explanted, after demonstrating significant LV recovery. CONCLUSION: We demonstrated the use of MCS as a bridge to decision in patients with LV thrombi, utilizing biatrial cannulation with a 'Y' connection to drain both right- and left-sided circulation through a single circuit and pump.