Short-term CentriMag® Support in INTERMACS 1–2 Cardiogenic Shock: Lessons from A Single-Center Experience

Objective: Acute cardiogenic shock (CS) developing in the setting of chronic heart failure is associated with high mortality and requires rapid hemodynamic intervention. This study aimed to evaluate the early outcomes of patients who received short-term mechanical circulatory support with the CentriMag® system for refractory CS and to assess the effectiveness of this strategy as a bridge therapy. Methods: This retrospective, single-center study included 30 consecutive patients who had been listed for heart transplantation and underwent CentriMag® short-term ventricular assist device (VAD) implantation due to the development of CS between September 2010 and December 2013 in our hospital. CS was defined as persistent low cardiac output despite inotropic therapy and intra-aortic balloon pump support. The primary endpoints were survival to hospital discharge and successful bridging to recovery, durable support, or heart transplantation. Secondary endpoints included hemodynamic and laboratory improvement as well as device-related complications. Results: The mean age of the patients was 32.7±15.2 years, and 70% were male. The mean left ventricular ejection fraction was 20.1%±4.0%. The most common etiologies of CS were idiopathic dilated cardiomyopathy (36.7%) and ischemic cardiomyopathy (26.7%). The most frequent post-operative complications were arrhythmia (36.6%), acute kidney injury (40%), and infection (33.3%). The mean duration of support was 33 days (range, 4–185). Eight patients (26.7%) were successfully bridged to heart transplantation and four (13.3%) to durable VAD support, while the 30-day survival rate was 60%. Conclusion: The CentriMag® short-term VAD provided effective hemodynamic stabilization, improved end-organ function, and enabled bridging to durable support or heart transplantation in a substantial proportion of patients with refractory CS. Despite the high complication rates inherent in this critically ill population, the survival outcomes were more favorable compared with conventional therapy. The CentriMag® system appears to be a reliable bridge-to-decision or bridge-to-transplant option for patients with advanced heart failure presenting with acute CS.