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Rescue Levitronix Centrimag as a bridge to decision: is it still worthwhile?

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Aim

Cardiogenic shock has poor prognosis with medical management alone and/or intra-aortic balloon pump support. Levitronix Centrimag®centrifugal pump has been increasingly used to bridge patients to decision for further advanced mechanical uni- or bi-ventricular support with a view to heart transplantation on the newly implemented super-urgent recipient scheme. We sought to review our experience as a designated centre for mechanical circulatory support to investigate its role despite the emergence of percutaneously implantable miniature devices.

Methods

Between April 2009 and December 2015, 98 patients in cardiogenic shock [age 41.4 ± 12.7 years; 52 (53%) male and 46 (47%) female] underwent mechanical circulatory support of whom 90 were treated with Levitronix Centrimag as a primary procedure. Diagnosis was dilated cardiomyopathy [37 (38.1%)], ischaemic cardiomyopathy [25 (25.8%)], and other [36 (36.1%)]. Main indications were cardiogenic shock or decompensated heart failure. Other indications were early graft failure following heart transplant or right ventricular failure following left ventricular assist device insertion. Levitronix support was as follows: extra corporeal membrane oxygenation [22 (24.4%) central, 26 (28.9%) peripheral], Left Ventricular Assist Device [12 (13.3%)], Right Ventricular Assist Device [5 (5.6%)], and Bi-Ventricular Assist Device [25 (27.8%)].

Results

The average duration of support on Levitronix was 17.1 days (range 1–111). The 30-day survival was 52% (47 patients), 6-month survival was 40% (36 patients), and 12-month survival was 37.7% (34 patients). Of the surviving patients, five underwent successful orthotopic heart transplantation, one received a HeartMate II which was subsequently explanted because of myocardial recovery, and one received a HeartMate II and is currently on the transplant list. Cause of death while on support was multiorgan failure [12 (13.3%)], cardiovascular system (CVA)/Neurological [10 (11.1%)], further haemodynamic deterioration [9 (10%)], graft failure [5 (5.6%)], bleeding [4 (4.4%)], sepsis [3 (3.3%)], myocardial infarction [3 (3.3%)], right ventricular failure [3 (3.3%)], pulmonary embolism [1 (1.1%)], embolic [1 (1.1%)], respiratory failure [1 (1.1%)], influenza + rejection [1 (1.1%)], and unknown [3 (3.3%)].

Conclusion

Levitronix Centrimag® remains a versatile device with potential in an acute setting. Early aggressive treatment and a younger patient population may well justify its use.

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Authors and Affiliations

  1. Cardiac Surgery and Transplantation, SNAHFS, GJNH, Glasgow, UK

    Massimo Capoccia, Sanjeet Avtaar Singh, Yasser Hegazy, Nawwar Al-Attar & Balakrishnan Mahesh

  2. Cardiac Anaesthesia, GJNH, Glasgow, UK

    Andrew Sinclair

Authors
  1. Massimo Capoccia
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  2. Sanjeet Avtaar Singh
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  3. Yasser Hegazy
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  4. Andrew Sinclair
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  5. Nawwar Al-Attar
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  6. Balakrishnan Mahesh
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Correspondence to Sanjeet Avtaar Singh.

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Conflict of interests

The authors declare that they have no conflict of interest.

Compliance with ethical standards

This is a retrospective observational study performed at the Golden Jubilee National Hospital and was approved by the clinical governance and ethics committee of the hospital. All patients had given informed consent. There was no funding for the study. The authors had no conflicts of interest(s) to declare. This article does not contain any studies with animals performed by any of the authors.

Additional information

This work has been presented as a Poster at EuroELSO 2016, 1–4 June 2016, Glasgow

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Capoccia, M., Avtaar Singh, S., Hegazy, Y. et al. Rescue Levitronix Centrimag as a bridge to decision: is it still worthwhile?. Indian J Thorac Cardiovasc Surg 33, 303–308 (2017). https://doi.org/10.1007/s12055-017-0582-2

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  • DOI: https://doi.org/10.1007/s12055-017-0582-2

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