Clinical experience with 439 patients with temporary Centrimag VAS – Implantation

Aims: The new CentriMag® VAS(Levitronix) is a continuous flow, magnetically levitated centrifugal-type rotary blood pump and supposed to provide effective temporary ventricular and respiratory support. It has been designed to operate without mechanical bearings or rotating seals, thus, reducing shear stress and minimizing the risk of hemolysis and thrombosis. The CentriMag® can be used in patients suffering from left, right or bi-ventricular failure.

Patients and methods: Since November 2004, 439 patients (302 male; mean age 58.39±15.07 (max 93 years old), BSA 1.91±0.23m²) required CentriMag VAS as temporary ventricular (430 patients), as respiratory (9 patients) and in 6 patients combined support (mean 11.83±18.79 days, max 183 days). At time of CentriMag® implantation 439 patients received high doses of inotropic support and 249 (56.7%) patients were on additional IABP support. The etiology for implantation was cardiogenic low output syndrom in 155 pts., postcardiotomy in 124 pts., AMI in 70 pts, 11 pts with RHF after HTX and 28 after LVAD implant, 18 pts with acute graft rejection after HTX, in 15 patients respiratory disorders(ARDS.lung edeme, pneumonia) etc and in 3 pts. pulmonary embolism and 13 patients with combined etiology. 169 patients needed CentriMag ECMO support, because of refractory to medical CPR therapy. In 274 patients we applied the CentriMag® as percutaneous cardiopulmonary bypass (femo-femoral) and in 155 patients as cardio pulmonary bypass (right atrium-A. pulmonalis), 6 patients A. pulmonals/V. pulmonalis with closed thorax, 1 pat V. femoralis/Aorta and 3 patients as BVAD as bridge to decision because of unclear neurologic situation of the patient.

Results: 219 (45.6%) of the patients expired under support, 25 pts died immediately and 33 pts several days after explantation. 74 patients could be successfully weaned, 12 patients were bridged to transplantation and 76 pts were bridged to long term mechanical circulatory support.

Conclusion: The result of CentriMag VAS as an acute life saving device and for bridge to decision (HTX, VAD-implantation) is satisfactory due to the high mortality rate of this patients with life threatening preconditions. A multidisciplinary approach with the VAD and HTX team together is necessary.