Contemporary mechanical circulatory support therapy for postcardiotomy shock.

Overview

Significant progress has been made in the use of mechanical circulatory support (MCS), particularly in the clinical success in durable left ventricular assist device. Short-term MCS has also advanced in the form of venoarterial extracorporeal membrane oxygenation, external centrifugal VADs as well as percutaneous VADs. Postcardiotomy shock (PCS) is a rare clinical entity associated with substantial morbidity and mortality. It is characterized by heart failure that either results in an inability to wean from cardiopulmonary bypass or that occurs in the immediate postoperative period, accounting for the most common indication for MCS. The reported in-hospital mortality of the PCS patients remains high, consistently over 50%, despite ongoing refinements of MCS technology. The optimization of selection criteria and the prompt institution of MCS are likely the keys to improving this persistently high mortality rate. Unfortunately, the lack of a clear definition for PCS in the literature limits scientific analyses and comparison of the existing evidence. To establish the treatment strategy and appropriately manage this challenging disease, substantial and fundamental effort by the cardiovascular society is imperative.