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J Thorac Cardiovasc Surg 2003;126:1634-1635
© 2003 The American Association for Thoracic Surgery

Brief communications

Implantation of a left ventricular assist device and the hub-and-spoke system in treating acute cardiogenic shock: Who survives?

Aftab R. Kherani, MDa, Faisal H. Cheema, MDa, Mehmet C. Oz, MDa, Jennifer M. Fal, BAa, Jeffrey A. Morgan, MDa, Veli K. Topkaraa, David A. Wilson, BAa, Deon W. Vigilance, MDa, Mauricio J. Garrido, MDa, Yoshifumi Naka, MD, PhDa,*

a Columbia University, College of Physicians and Surgeons, Division of Cardiothoracic Surgery, New York, NY, USA

Received for publication February 14, 2003; accepted for publication April 1, 2003.

* Address for reprints: Dr Y. Naka, New York Presbyterian Hospital, Columbia-Presbyterian Center, Division of Cardiothoracic Surgery, Millstein Hospital Bld 7-435, 177 Fort Washington Ave, New York, NY 10032, USA
yn22@columbia.edu

The first 20% of the full text of this article appears below.

We have established a regional referral network that facilitates the transfer of patients in cardiogenic shock to our center for definitive management. This "hub-and-spoke" network has proven to be effective in treating this critically ill population. Postcardiotomy shock complicates 2% to 6% of cardiac procedures.1 The incidence of cardiogenic shock following acute myocardial infarction (AMI) is 5% to 15%.2 Medical management composed of inotropes and pressors with or without intra-aortic balloon pump support represents the standard of care in treating these patients. The advent of left ventricular assist devices (LVADs) introduced a surgical option for cases refractory to medical management. This study delineates who survives in this population and how the postcardiotomy setting impacts device placement.

Methods

This was a retrospective review looking at the short-term outcome of the 46 patients transferred from 22 spoke institutions to 1 tertiary hub center between October 1993 and May . . . [Full Text of this Article]




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