Rescue Levitronix Centrimag as a bridge to decision: is it still worthwhile?

Massimo Capoccia, Sanjeet Avtaar Singh, Yasser Hegazy, Andrew Sinclair, Nawwar Al-Attar, Balakrishnan Mahesh

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: Cardiogenic shock has poor prognosis with medical management alone and/or intra-aortic balloon pump support. Levitronix Centrimag®centrifugal pump has been increasingly used to bridge patients to decision for further advanced mechanical uni- or bi-ventricular support with a view to heart transplantation on the newly implemented super-urgent recipient scheme. We sought to review our experience as a designated centre for mechanical circulatory support to investigate its role despite the emergence of percutaneously implantable miniature devices. Methods: Between April 2009 and December 2015, 98 patients in cardiogenic shock [age 41.4 ± 12.7 years; 52 (53%) male and 46 (47%) female] underwent mechanical circulatory support of whom 90 were treated with Levitronix Centrimag as a primary procedure. Diagnosis was dilated cardiomyopathy [37 (38.1%)], ischaemic cardiomyopathy [25 (25.8%)], and other [36 (36.1%)]. Main indications were cardiogenic shock or decompensated heart failure. Other indications were early graft failure following heart transplant or right ventricular failure following left ventricular assist device insertion. Levitronix support was as follows: extra corporeal membrane oxygenation [22 (24.4%) central, 26 (28.9%) peripheral], Left Ventricular Assist Device [12 (13.3%)], Right Ventricular Assist Device [5 (5.6%)], and Bi-Ventricular Assist Device [25 (27.8%)]. Results: The average duration of support on Levitronix was 17.1 days (range 1–111). The 30-day survival was 52% (47 patients), 6-month survival was 40% (36 patients), and 12-month survival was 37.7% (34 patients). Of the surviving patients, five underwent successful orthotopic heart transplantation, one received a HeartMate II which was subsequently explanted because of myocardial recovery, and one received a HeartMate II and is currently on the transplant list. Cause of death while on support was multiorgan failure [12 (13.3%)], cardiovascular system (CVA)/Neurological [10 (11.1%)], further haemodynamic deterioration [9 (10%)], graft failure [5 (5.6%)], bleeding [4 (4.4%)], sepsis [3 (3.3%)], myocardial infarction [3 (3.3%)], right ventricular failure [3 (3.3%)], pulmonary embolism [1 (1.1%)], embolic [1 (1.1%)], respiratory failure [1 (1.1%)], influenza + rejection [1 (1.1%)], and unknown [3 (3.3%)]. Conclusion: Levitronix Centrimag® remains a versatile device with potential in an acute setting. Early aggressive treatment and a younger patient population may well justify its use.

Original languageEnglish (US)
Pages (from-to)303-308
Number of pages6
JournalIndian Journal of Thoracic and Cardiovascular Surgery
Volume33
Issue number4
DOIs
StatePublished - Dec 1 2017

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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