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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

The CentriMag ventricular assist device in acute heart failure refractory to medical management

      Background

      The CentriMag ventricular assist device (VAD) has gained popularity in the last several years as rescue support for patients with decompensated heart failure. We have used the CentriMag VAD as a bridge to decision device. We describe our experience with device placement, use and outcomes.

      Methods

      This is a retrospective study of all patients who underwent CentriMag placement at our institution from January 2007 to August 2009. Sixty-three patients had placement of a CentriMag device, with 43% (n = 27) of these being placed due to failure of medical management. These cases were the focus of our study.

      Results

      Primary diagnoses were ischemic cardiomyopathy (n = 17), dilated cardiomyopathy (n = 7) or other (n = 3). Mean age was 47.1 (range 7 to 72) years. Prior to implant, 85% of patients were on intra-aortic balloon pump (IABP) support, 70% were on vasopressors, and 44% were on more than one inotrope. INTERMACS score was 1 in 67% of patients and 2 in 33% of patients. Six patients were bridged to a long-term device, 8 to transplantation and 10 to recovery. Eighty-nine percent (24 of 27) of patients survived to explant and 74% (20 of 27) survived to hospital discharge, with a 1-year survival of 68%. Thromboembolic complications occurred in 10 patients, including 6 strokes. Compared with patients who survived to discharge, those who died had a significantly higher body mass index (30.8 vs 24.1 kg/m2, p = 0.003). Survivors to discharge demonstrated significant improvements in hepatic and renal function over the course of device support while non-survivors did not.

      Conclusions

      The CentriMag demonstrates promising results when used in patients with acute heart failure refractory to medical management.

      Keywords

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      References

        • Lloyd-Jones D.
        • Adams R.J.
        • Brown T.M.
        • et al.
        Heart disease and stroke statistics 2010 update: a report from the American Heart Association.
        Circulation. 2010; 121: e46-e216
        • Rose E.A.
        • Gelijns A.C.
        • Moskowitz A.J.
        • et al.
        Long-term use of a left ventricular assist device for end-stage heart failure.
        N Engl J Med. 2001; 345: 1435-1443
        • Rao V.
        • Oz M.C.
        • Flannery M.A.
        • et al.
        Revised screening scale to predict survival after insertion of a left ventricular assist device.
        J Thorac Cardiovasc Surg. 2003; 125: 855-862
        • Oz M.C.
        • Gelijns A.C.
        • Miller L.
        • et al.
        Left ventricular assist devices as permanent heart failure therapy.
        Ann Surg. 2003; 238: 577-585
        • Miller L.W.
        • Nelson K.E.
        • Bostic R.R.
        • et al.
        Hospital costs for left ventricular assist devices for destination therapy: lower costs for implantation in the post-REMATCH era.
        J Heart Lung Transplant. 2006; 25: 778-784
        • Bhama J.K.
        • Kormos R.L.
        • Toyoda Y.
        • et al.
        Clinical experience using the Levitronix CentriMag system for temporary right ventricular mechanical circulatory support.
        J Heart Lung Transplant. 2009; 28: 971-976
        • Takayama H.
        • Chen J.M.
        • Jorde U.P.
        • et al.
        Implantation technique of the CentriMag biventricular assist device allowing ambulatory rehabilitation.
        Interact Cardiovasc Thorac Surg. 2011; 12: 110-111
        • John R.
        • Liao K.
        • Lietz K.
        • et al.
        Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure.
        J Thorac Cardiovasc Surg. 2007; 134: 351-358
        • Shuhaiber J.H.
        • Jenkins D.
        • Berman M.
        • et al.
        The Papworth experience with the Levitronix CentriMag ventricular assist device.
        J Heart Lung Transplant. 2008; 27: 158-164
        • De Robertis F.
        • Birks E.J.
        • Rogers P.
        • et al.
        Clinical performance with the Levitronix CentriMag short-term ventricular assist device.
        J Heart Lung Transplant. 2006; 25: 181-186
        • De Robertis F.
        • Rogers P.
        • Amrani M.
        • et al.
        Bridge to decision using the Levitronix CentriMag short-term ventricular assist device.
        J Heart Lung Transplant. 2008; 27: 474-478
        • Fitzpatrick III, J.R.
        • Frederick J.R.
        • Hiesinger W.
        • et al.
        Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device.
        J Thorac Cardiovasc Surg. 2009; 137: 971-977