Med Intensiva (Engl Ed)
Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
Published: June 2022
Postcardiotomy cardiogenic shock represents the most serious expression of low cardiac output syndrome after cardiac surgery. Although infrequent, it is a relevant condition due to its specific and complex pathophysiology and important morbidity-mortality. The diagnosis requires a high index of suspicion and multimodal hemodynamic monitoring, where echocardiography and the pulmonary arterial catheter play a main role. Early and multidisciplinary management should focus on the management of postoperative or mechanical complications and the optimization of determinants of cardiac output through fluid therapy or diuretic treatments, inotropic drugs and vasopressors/vasodilators and, in the absence of a response, early mechanical circulatory support. The aim of this paper is to review and update the pathophysiology, diagnosis and management of postcardiotomy cardiogenic shock.
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http://dx.doi.org/10.1016/j.medine.2022.04.014 | DOI Listing |
Med Intensiva (Engl Ed)
January 2025
Servicio ECMO, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia.
Objective: To document the experience with ECMO therapy in healthcare institutions across Latin America between 2016 and 2020.
Design: Cross-sectional study.
Setting: Private and public health institutions from 7 countries.
Front Cardiovasc Med
December 2024
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Background: Acute type A aortic dissection (ATAAD) poses significant challenges in cardiovascular management due to its high morbidity and mortality rates. Postcardiotomy cardiogenic shock (PCS) is a severe complication following ATAAD repair that complicates postoperative recovery. Extracorporeal membrane oxygenation (ECMO) has emerged as a potential life-saving intervention in this context, yet the specific outcomes related to ECMO in ATAAD patients remain insufficiently studied.
View Article and Find Full Text PDFInterdiscip Cardiovasc Thorac Surg
December 2024
Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan.
Patients with low-flow, low-gradient severe aortic stenosis and ischaemic cardiomyopathy are at risk for postcardiotomy cardiogenic shock and have a poor prognosis. Although Impella has emerged as a bridge therapy, traditional approaches for Impella insertion are infeasible in patients with peripheral vascular diseases. We successfully managed postcardiotomy cardiogenic shock in a patient with low-flow, low-gradient severe aortic stenosis and ischaemic cardiomyopathy and limited vascular access by introducing Impella via the brachiocephalic artery.
View Article and Find Full Text PDFExpert Rev Med Devices
December 2024
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Introduction: The Impella 5.5 device is a surgically inserted, trans-valvular, microaxial flow device capable of providing 5.5 L/min of continuous, antegrade flow from the left ventricle (LV) to the aorta.
View Article and Find Full Text PDFUS Cardiol
August 2024
Division of Cardiology and Department of Critical Care, MedStar Washington Hospital Center Washington, DC.
Patients undergoing cardiac surgery experience significant physiologic derangements that place them at risk for multiple shock phenotypes. Any combination of cardiogenic, obstructive, hemorrhagic, or vasoplegic shock occurs commonly in post-cardiotomy patients. The approach to the diagnosis and management of these shock states has many facets that are distinct compared to non-surgical cardiac intensive care unit patients.
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