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Cardiogenic shock: Who benefits from heart replacement therapy?

Miloud Cherbi1, François Roubille2, Nicolas Lamblin3

  • 1Intensive Cardiac Care Unit, University Hospital of Toulouse, Toulouse, France; Université Paul Sabatier - Toulouse III, Toulouse, France.

International Journal of Cardiology
|November 9, 2025
PubMed

Insights

Heart replacement therapy (HRT) was used in over 10% of cardiogenic shock (CS) patients, with similar in-hospital mortality to those not receiving HRT. Further research is needed to refine HRT selection criteria for CS.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Transplantation

Background:

  • Characteristics of patients needing heart replacement therapy (HRT) for cardiogenic shock (CS) are not well-defined.
  • This study aims to describe the clinical profile of CS patients undergoing HRT.

Purpose of the Study:

  • To characterize the clinical profile of cardiogenic shock patients undergoing heart replacement therapy.
  • To determine the rates of in-hospital HRT and HRT between discharge and 1-year follow-up in CS patients.

Main Methods:

  • Prospective registry (FRENSHOCK) of 772 CS patients across 49 centers.
  • HRT included heart transplantation (HTx) and ventricular assist devices (VADs).
  • Primary endpoint: in-hospital HRT rate; Secondary endpoint: HRT rate from discharge to 1-year follow-up.

Main Results:

  • 6.3% of patients received in-hospital HRT (34 HTx, 15 VADs); 3.8% received HRT between discharge and 1-year follow-up.
  • Independent factors for in-hospital HRT included prior ICD, right heart failure signs, elevated bilirubin, dobutamine/levosimendan use, and acute mechanical circulatory support (aMCS).
  • Ventricular arrhythmia and aMCS were associated with HRT between discharge and 1-year follow-up.

Conclusions:

  • Over 10% of unselected CS patients received HRT (in-hospital or by 1-year follow-up).
  • In-hospital mortality rates were comparable between HRT and non-HRT CS patients.
  • Further studies are required to optimize HRT selection criteria in CS.
Abstract

Keywords:
Cardiogenic shockHeart transplantationPrognosisVentricular assist device

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