Skirted Cannula Technique for Apical Cannulation in Implantation of Centrimag Left Ventricular Assist Device.

The CentriMag, an extracorporeal short-term ventricular assist device designed for treatment of patients with acute cardiogenic shock, is Conformité Européenne-marked in Europe for use up to 30 days. Extended use beyond the licensed period is not uncommon, however. We have developed a skirted cannula technique for apical cannulation in implantation of the Centrimag. This technique allows easy positioning of the cannula and excellent hemostasis. It also offers secure fixation of the cannula so that patients can ambulate and attend rehabilitation programs should extended use be anticipated.

Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation.

Bupropion inhibits the uptake of dopamine and norepinephrine. Clinical effects in overdose include seizure, status epilepticus, tachycardia, arrhythmias, and cardiogenic shock. We report two cases of severe bupropion toxicity resulting in refractory cardiogenic shock, cardiac arrest, and repeated seizures treated successfully. Patients with cardiovascular failure related to poisoning may particularly benefit from extracorporeal membrane oxygenation (ECMO). These are the first cases of bupropion toxicity treated with veno-arterial EMCO (VA-ECMO) in which bupropion toxicity is supported by confirmatory testing. Both cases demonstrate the effectiveness of VA-ECMO in poisoned patients with severe cardiogenic shock or cardiopulmonary failure.

Implantation technique of the CentriMag biventricular assist device allowing ambulatory rehabilitation.

Non-implantable ventricular assist device plays a major role in emergent or urgent situation where a patient has acutely decompensating hemodynamics. One of its major disadvantages is that the patient needs to be bed-bound after insertion. We have developed a surgical technique that allows ambulatory management of the patients who received non-implantable device with CentriMag.

Puente al trasplante de 4 semanas utilizando el sistema de asistencia ventricular Levitronix Centrimag® en el shock cardiogénico post-infarto al miocardio: Caso clínico / Four-week Levitronix Centrimag® bridge-to-transplant for post myocardial infarction cardiogenic shock: A case report

Cardiogenic shock after myocardial infarction has a high mortality even if early revascularization is achieved. Biventricular assist devices have not been used in Chile in this critical setting. We report a case of a 55 year-old diabetic man who suffered an acute chest pain and ventricular fibrillation. Prompt outside hospital defibrillation/ reanimation restored pulse and allowed emergency room transfer on mechanical ventilation. Electrocardiogram showed an anterior myocardial infarction and early revascularization was achieved by anterior descending artery angioplasty. However, severe cardiogenic shock continued in spite of inotropic and intra aortic balloon pump support. Levitronix Centrimag® biventricular mechanical circulatory support was inserted during reanimation for recurrent ventricular fibrillation and the patient listed for urgent cardiac transplantation upon stabilization. Heart transplantation was performed successfully 28 days later and the patient was discharged after a 21-day recovery period. Twelve months after transplant the patient is in NYHA functional class I with normal biventricular function. Levitronix Centrimag® biventricular mechanical circulatory support could be used successfully as a bridge-to-transplant for myocardial infarction cardiogenic shock.

Desenvolvimento de um coração artificial para suporte circulatório / Development of an artificial heart circulatory support

O presente trabalho descreve o desenvolvimento de uma bomba centrífuga magnética, portátil de fácil instalação e baixo custo, que pode ser utilizada em pacientes que precisam de suporte ciculatório temporário e que foi empregada em 65 pacientes submetidos a cirurgia cardíaca

Long-term follow-up of postcardiotomy patients with profound cardiogenic shock treated with ventricular assist devices.

Success of ventricular assist devices in patients with postcardiotomy shock has provided enough survivors to allow evaluation of the length and quality of life. Fifteen survivors from 28 to 68 years (mean 53) old from four centers were followed for 6 to 77 months (mean 35) after discharge from the hospital. Four patients suffered perioperative myocardial infarctions. In three patients, ventricular function was normal before surgery and remained so afterward. Of 12 patients with moderate or severely impaired ventricular function, five improved, five were unchanged, and two were worse. One patient died 6 months after surgery of cardiomyopathy. Seven patients are employed full-time and one works part-time. Five patients are retired but active and one is moderately disabled. NYHA functional class improved in the patients as a group: 13 were in classes III and IV before surgery and 13 were in classes I and II after surgery. Two patients had noncardiac partial disability. Survivors of ventricular assist device support for postcardiotomy shock have an excellent chance for high-quality life and the risk of crippling cardiac disability is small.