Emergency ventricular assist device: Better survival rates in non-post cardiotomy-related cardiogenic shock

Objective : the Abiomed BVS 5000 ventricular assist device (VAD) has been a pproved in Belgium for emergency cardiac support in patients with postcardi otomy failure with the aim of native heart function recovery. Other indicat ions have emerged from world wide experience, but the indication and useful ness of emergency implantation of assist devices is often debated. Methods : to decide which patients benefit most from emergency ventricular assist device implantation, we retrospectively reviewed our results of mech anical circulatory support with Abiomed in 20 patients over a 4-year period . Fifteen patients with mean age 58 +/- 6 years experienced postcardiotomy failure and underwent biventricular assist device (BVAD) implantation (grou p A), after elective (n = 9) or after emergency coronary artery bypass graf ting (CABG) (n = 6). Five patients (group B), with mean age 35 +/- 19 years , had an implantation for other underlying conditions hypertrophic cardiomy opathy (n = 3), myocarditis (n = 1) and primary cardiac allograft failure ( n = 1). Results : Of these two groups, eight and two patients respectively needed c ardiopulmonary resuscitation before VAD implantation. The mean duration of support in both groups was 5.8 (range 12h-13days) and 4.4 days (range 2h-9d ays) respectively. Six and two patients could be weaned from the device and nine and one patie nts respectively, died on the device. Two patients in group B underwent suc cesful heart transplantation and four patients in group A died after weanin g. Two patients in the postcardiotomy group and four patients in group B su rvived (13% and 80%) with an overall survival and discharge rate of 30%. Conclusion : although sample sizes are small, better survival rates with em ergency Abiomed BVS 5000 implantation were obtained in the non postcardioto my group (group B). For patients in the postcardiotomy group, outcome was n egatively influenced by cardiac arrest and resuscitation before urgent CABG . Since death is the only alternative for these patients in cardiogenic sho ck and organ recovery cannot be predicted, we continue to consider emergenc y VAD implantation in this patient population.