Ventricular assist device therapy in post-cardiotomy cardiogenic shock: historical outcomes and current trends

Ventricular assist device (VAD) therapy has been used successfully as a bridge to recovery, bridge to transplant and in the last decade as a destination therapy. The use of VAD for post-cardiotomy cardiogenic shock (PCCS) is not currently reported in national databases in the UK and Ireland. Data were collected through a telephone survey of chief perfusionists from all the cardiac surgery units in the UK and Ireland between October 2007 and October 2008. Approximately 28 000 adult cardiac surgical procedures were performed at 45 cardiac centres, of which 33 (73%) reported using VAD. The total number of patients supported was 66, of which 41% (n = 27) survived to be discharged home. About 42.5% (n = 28) died during VAD in place, and 16.5% died after successful weaning from VAD. Preferences for device types were Biomedicus (n = 25), Levitronix (n = 10), Sorin (n = 3), roller pump (n = 3) and Berlin heart (n = 2). Despite the reasonable survival rates after VAD use in post-cardiotomy heart failure, there are significant differences in their availability and individual's attitude towards their use. VAD use in PCCS should be prospectively documented in the audit returns of all the units, for further analysis and for generation of protocols.