Introduction
Postcardiotomy cardiogenic shock (PCCS), defined by inadequate end-organ
perfusion due to low cardiac output, occurs after 1-5% of cardiac
surgical procedures, and in about 1% of cases, patients may require
postoperative mechanical circulatory support (MCS).1,2The typical presentation of PCCS is decreasing cardiac function along
with the difficulty or inability to wean from cardiopulmonary bypass
without high-dose inotropic support and/or advanced MCS. Current MCS
strategies include the use of intra-aortic balloon (IABP)
counterpulsation, extracorporeal membrane oxygenation (ECMO),
percutaneously-implanted or surgically implanted left ventricular assist
devices, or a combination of devices.1 Despite
advances in the development of support strategies, in-hospital mortality
following PCCS remains high, with reports ranging from
40-90%.3–10
Due to the high costs of MCS usage following PCCS, along with the
propensity for increased rates of further complication, prolonged
intensive care and hospital stays, and ultimately high rate of death, it
is often debated whether these measures are beneficial or futile.
Furthermore, the long-term outcomes in survivors of PCCS have not been
well-studied. Therefore, this study aimed to investigate our experience
in using de novo MCS for PCCS following cardiac surgery, and examine
short and long-term outcomes.