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J Thorac Cardiovasc Surg 2007;134:351-358
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure

Ranjit John, MDa,*, Kenneth Liao, MDa, Katherine Lietz, MD, PhDb, Forum Kamdar, BSa, Monica Colvin-Adams, MDb, Andrew Boyle, MDb, Leslie Miller, MDb, Lyle Joyce, MD, PhDa

a Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
b Division of Cardiology, University of Minnesota, Minneapolis, Minn.

Received for publication September 26, 2006; revisions received January 22, 2007; accepted for publication January 29, 2007.

* Address for reprints: Ranjit John, MD, Assistant Professor, Division of Cardiothoracic Surgery, 420 Delaware St SE, MMC 207, University of Minnesota, Minneapolis, MN 55455. (Email: johnx008{at}umn.edu).

Objective: Patients with refractory acute cardiogenic shock and multisystem organ failure have a poor outcome with implantation of permanent ventricular assist devices. We review our experience with the use of the CentriMag (Levitronix LLC, Waltham, Mass) circulatory support system in such patients whose neurologic status was uncertain.

Methods: From January 2004 to June 2006, 30 patients underwent CentriMag circulatory support system placement at the University of Minnesota. Of these patients, 12 were transferred from an outside hospital with refractory acute cardiogenic shock requiring biventricular support; they are the focus of this study.

Results: Of our 12 study patients, 8 underwent successful bridging to the HeartMate XVE (Thoratec Corp, Pleasanton, Calif) ventricular assist device after biventricular support (mean support time of 9.4 days, range: 5–22 days). Another 2 patients underwent successful explantation (after 8 and 9 days); the remaining 2 patients died (after 4 days). Thus, the survival on CentriMag support, to either bridge or recovery, was 83% (10/12). Of the 8 patients who subsequently underwent HeartMate implantation, 5 also underwent a heart transplant within 6.9 months (range, 4.5-10 months), another 2 are still awaiting a transplant, and 1 died of sepsis and right ventricular failure 3 days after HeartMate implantation. Thus, for our 12 study patients, long-term survival was 75% at 1 month and 62.5% at 1 year.

Conclusions: Our aggressive strategy in this group of patients involved early operative intervention and implantation of biventricular support. By using this strategy, we avoided the urgent placement of expensive long-term ventricular assist devices in hemodynamically unstable patients with multisystem organ failure whose neurologic status was uncertain until end-organ recovery and excellent hemodynamic stability were achieved with the relatively inexpensive short-term CentriMag circulatory support system. The excellent midterm outcomes in this group of patients whose original prognosis was poor justify this therapeutic strategy.

Abbreviations and Acronyms ACT = activated clotting time; ECMO = extracorporeal membrane oxygenation; GCS = Glasgow Coma Scale; IABP = intraaortic balloon pump; LVAD = left ventricular assist device; MSOF = multisystem organ failure; RVAD = right ventricular assist device; SCr = serum creatinine; VAD = ventricular assist device




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