RARE DISEASE
Postcardiotomy right ventricular failure
Postcardiotomy right ventricular failure
Postcardiotomy right ventricular failure
Drug discovery
1
drug
With orphan designation
Overview
Postcardiotomy right ventricular failure (RVF) is a rare but life-threatening complication following cardiac surgery, characterized by acute RV dysfunction leading to hemodynamic instability. It arises from factors like ischemia-reperfusion injury, pulmonary hypertension, or preexisting RV dysfunction, with an incidence of 0.04–2.9% depending on surgical context [1][6][9]. RVF correlates with severe outcomes, including prolonged ICU stays, multi-organ failure, and mortality rates up to 70–75% in refractory cases [1][6][14]. Management involves optimizing RV preload, reducing afterload, and mechanical support.
Categories: rare cardiac diseases
Research Papers
570 drug discovery papers about Postcardiotomy right ventricular failure, with 1 first-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
570 drug discovery papers about Postcardiotomy right ventricular failure, with 1 first-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
categories:
Small molecules
cell therapies
2026-04-23 | Postcardiotomy veno-arterial membrane oxygenation as a bridge to heart replacement therapies.
Data on the outcome of veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) support as a bridge to replacement therapies are scarce. We investigated the outcome of V-A-ECMO support after adult cardiac surgery as a bridge to ventricular assist device (VAD) implantation and/or heart transplantation. This is a retrospective, multicenter study recruiting patients who underwent heart transplantation or VAD implantation immediately after postcardiotomy V-A-ECMO for persistent heart failure at 14 European centers of cardiac transplantation from 2010 to 2024. Ninety-four consecutive patients were treated at 14 European centers of cardiac transplantation from 2010 to 2024. In-hospital mortality after replacement therapy was 31.9%, while it was 35.2% (19/54 patients) after primary VAD implantation and 27.5% (11/40 patients) after primary heart transplantation (p = 0.429) after V-A-ECMO. Five-year all-cause mortality of the overall series was 52.4%. Five-year mortality was 66.0% after primary VAD and 32.7% after primary heart transplantation (adjusted HR 0.420, 95%CI 0.199-0.885). Sixty-four patients underwent heart transplantation any time after V-A-ECMO support and had a 5-year mortality rate of 34.9%, while it was 83.9% among 32 patients who received VAD support only (p < 0.0001). The present findings support a bridge policy to heart replacement in selected postcardiotomy V-A-ECMO patients. Primary heart transplantation after V-A-ECMO support may be associated with better survival. The small size of this series and its results suggest that a larger study is needed to confirm these findings and could strengthen external validity and enhance the applicability of the results across different healthcare settings.
2026-03-28 | Design and rationale of the Impella®-protected cardiac surgery trial (IMPACT): A multicenter, single-arm pilot study in high-risk cardiac surgery patients.
Cardiac surgery patients with severe preoperative left ventricular (LV) dysfunction are at high risk for poor postoperative outcomes including prolonged ventilation, renal failure and post-cardiotomy cardiogenic shock (PCCS). Mortality and morbidity remain high for patients who develop PCCS, thus mandating the availability of more effective prophylactic and treatment options. The Impella®-Protected Cardiac Surgery Trial (IMPACT) is a prospective, multicenter, single-arm pilot study assessing Impella 5.5® use prior to weaning from cardiopulmonary bypass in high-risk cardiac surgery patients. Key inclusion criteria are a baseline LV ejection fraction ≤25% or ≤35% with significant mitral regurgitation and planned mitral valve replacement or repair (MVR), and undergoing planned, on-pump isolated coronary artery bypass grafting, MVR, aortic valve replacement, or a combination of these with or without tricuspid valve replacement. The primary effectiveness endpoint is the rate of PCCF at hospital discharge. The primary safety endpoint is the composite of all-cause mortality, stroke and new requirement for renal replacement therapy evaluated through 90 days post-operation. Additional secondary endpoints include hospital and ICU lengths of stay, vasoactive-inotropic score, duration of mechanical ventilation and cardiovascular mortality. A concurrent registry will aim to collect data on patients not approached for study enrollment or who do not meet all inclusion and exclusion criteria. IMPACT results will provide data on trial and technique feasibility, patient selection criteria and aid in informing future trial designs. ClinicalTrials.gov, NCT05529654, https://clinicaltrials.gov/study/NCT05529654.
2025-12-16 | Survival against the ODDS-ESMO in postcardiotomy cardiogenic shock
Introduction. Postcardiotomy cardiogenic shock is a severe complication of cardiac surgery, often requiring mechanical circulatory support and associated with high mortality. We present a case illustrating the complex management of biventricular failure, atrial fibrillation, and ischemic cardiomyopathy from emergency admission to surgical recovery. Case Report. A 67-year-old man presented with dyspnoea, hypotension, and facial and peripheral oedema. Echocardiography revealed severe biventricular dysfunction with a left ventricular ejection fraction of 15%, right ventricular failure, and severe tricuspid regurgitation. On admission, he developed atrial fibrillation, managed with inotropes, diuretics, and cautious rate control. Diagnostic work-up revealed multivessel coronary and significant carotid artery disease. The patient underwent urgent triple coronary artery bypass grafting, tricuspid annuloplasty, left carotid endarterectomy, box pulmonary vein isolation, and left atrial appendage occlusion. Intraoperatively, refractory cardiogenic shock necessitated veno-arterial extracorporeal membrane oxygenation with left ventricular venting. Mechanical circulatory support was successfully weaned after three days as cardiac function improved. Postoperative recovery was complicated by Clostridioides difficile enterocolitis and fungal pneumonia. He was discharged on postoperative day 36, and at six months remained clinically stable with improved functional capacity. Conclusion. This case underscores the importance of a multidisciplinary approach in managing complex cardiac patients. Early hemodynamic assessment, individualized therapy, and timely initiation of extracorporeal membrane oxygenation were critical to survival. In this setting, extracorporeal membrane oxygenation proved to be an effective bridge to recovery, emphasizing its value in select high-risk cases of postcardiotomy cardiogenic shock.
2025-12-15 | Right Ventricular-Pulmonary Artery Cannulation in Right Ventricular Failure: An Updated Narrative Review.
Right ventricular (RV) failure is a life-threatening condition contributing to morbidity and mortality in several pathological conditions, particularly in postcardiotomy shock, advanced heart failure, pulmonary embolism, and severe respiratory disease. Temporary mechanical circulatory support has gained increasing attention in refractory conditions, with dual-lumen cannulation strategies specifically designed to facilitate such a support modality, decompress the right atrium or ventricle while preserving antegrade pulmonary blood flow and allowing, in case of need, concomitant RV and respiratory support. A narrative review was conducted through PubMed, identifying English-language, peer-reviewed articles published between January 2011 and September 2025. The search combined the term "dual lumen pulmonary artery cannula" with related keywords including "pulmonary artery cannulation", "right atrium to pulmonary artery cannulation", "percutaneous right ventricular assist", "temporary RVAD", "oxygenated RVAD", and "right-sided mechanical circulatory support". Eligible studies included case reports, series, cohort studies, and reviews. Structured institutional resources were also evaluated to complement evidence with practical insights. Twenty-one publications were identified, of which 13 met the inclusion criteria. Reports consistently highlighted the rationale for RV unloading, clinical indications across postcardiotomy shock, LVAD-related dysfunction, pulmonary embolism, and ARDS, and described standardized insertion through the right internal jugular vein with imaging guidance. Complications included cannula malposition, thromboembolism, bleeding, and infection, while support durations typically ranged from 7 to 14 days, although its incidence is lower with jugular access compared with femoral approaches and open chest procedures. Weaning rates ranged between 40% and 70% of cases, with early initiation of support associated with improved survival. Dual-lumen right atrium/ventricle-to-pulmonary artery cannulation represents a feasible and physiologically advantageous option for temporary isolated RV or concomitant RV and respiratory support. Current evidence, however, is limited to small observational studies, underscoring the need for multicenter registries, uniform nomenclature, and prospective trials to establish standardized protocols and clarify its role relative to alternative right-sided support strategies.
2024-09-27 | Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock.
Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.
proteins
2022-07-19 | Recombinant human brain natriuretic peptide ameliorates venous return function in congestive heart failure.
Recombinant human brain natriuretic peptide (rh-BNP) is commonly used as a decongestive therapy. This study aimed to investigate the instant effects of rh-BNP on cardiac output and venous return function in post-cardiotomy patients with congestive heart failure (CHF). Twenty-four post-cardiotomy heart failure patients were enrolled and received a standard loading dose of rh-BNP. Haemodynamic monitoring was performed via a pulmonary artery catheter before and after the administration of rh-BNP. The cardiac output and venous return functions were estimated by depicting Frank-Starling and Guyton curves. After rh-BNP infusion, variables reflecting cardiac congestion and venous return function, such as pulmonary artery wedge pressure, mean systemic filling pressure (Pmsf) and venous return resistance index (VRRI), reduced from 15 ± 3 to 13 ± 3 mmHg, from 32 ± 7 to 28 ± 7 mmHg and from 6.7 ± 2.6 to 5.7 ± 1.8 mmHg min m2 /L, respectively. Meanwhile, cardiac index, stroke volume index, and the cardiac output function curve remained unchanged per se. The decline in Pmsf [-13% (-22% to -8%)] and VRRI [-12% (-25% to -5%)] was much greater than that in the systemic vascular resistance index [-7% (-14% to 0%)]. In the subgroup analysis of reduced ejection fraction (<40%) patients, the aforementioned changes were more significant. rh-BNP might ameliorate venous return rather than cardiac output function in post-cardiotomy CHF patients.
2019-04-09 | Terlipressin versus norepinephrine to prevent milrinone-induced systemic vascular hypotension in cardiac surgery patient with pulmonary hypertension
Milrinone at inotropic doses requires the addition of a vasoconstrictive drug. We hypothesized that terlipressin use could selectively recover the systemic vascular hypotension induced by milrinone without increasing the pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) as norepinephrine in cardiac surgery patients.Patients with pulmonary hypertension were enrolled in this study. At the start of rewarming a milrinone 25 μg/kg bolus over 10 min followed by infusion at the rate of 0.25 μg/kg/min. Just after the loading dose of milrinone, the patients were randomized to receive norepinephrine infusion at a dose of 0.1 μg/kg/min (norepinephrine group) or terlipressin infusion at a dose of 2 μg/kg/h (terlipressin group). Heart rate, mean arterial blood pressure (MAP), central venous pressure, MPAP, systemic vascular resistance (SVR), PVR, cardiac output were measured after induction of anesthesia, after loading dose of milrinone, during skin closure, and in the intensive care unit till 24 h.Milrinone decreased MAP (from 79.56 ± 4.5 to 55.21 ± 2.1 and from 78.46 ± 3.3 to 54.11 ± 1.1) and decreased the MPAP (from 59.5 ± 3.5 to 25.4 ± 2.6 and from 61.3 ± 5.2 to 25.1 ± 2.3) in both groups. After norepinephrine, there was an increase in the MAP which is comparable to terlipressin group (P > 0.05). Terlipressin group shows a significant lower MPAP than norepinephrine group (24.5 ± 1.4 at skin closure vs. 43.3 ± 2.1, than 20.3 ± 2.1 at 24 h vs. 39.8 ± 3.8 postoperatively). There is a comparable increase in the SVR in both group, PVR showed a significant increase in the norepinephrine group compared to the terlipressin group (240.5 ± 23 vs. 140.6 ± 13 at skin closure than 190.3 ± 32 vs. 120.3 ± 10 at 24 h postoperatively).The use of terlipressin after milrinone will reverse systemic hypotension with lesser effect on the pulmonary artery pressure.
2016-12-14 | Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function
Abstract We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine–vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine–vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as “responders” if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine–vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1–26.9), and the median weight was 4.3 kg (3.2–5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the “target” arginine–vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine–vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.
2009-02-23 | Vasopressin decreases intestinal mucosal perfusion: a clinical study on cardiac surgery patients in vasodilatory shock
Background: Low to moderate doses of vasopressin have been used in the treatment of cathecholamine‐dependent vasodilatory shock in sepsis or after cardiac surgery. We evaluated the effects of vasopressin on jejunal mucosal perfusion, gastric‐arterial p CO 2 gradient and the global splanchnic oxygen demand/supply relationship in patients with vasodilatory shock after cardiac surgery. Methods: Eight mechanically ventilated patients, dependent on norepinephrine to maintain mean arterial pressure (MAP) ≥60 mmHg because of septic/post‐cardiotomy vasodilatory shock and multiple organ failure after cardiac surgery, were included. Vasopressin was sequentially infused at 1.2, 2.4 and 4.8 U/h for 30‐min periods. Norepinephrine was simultaneously decreased to maintain MAP at 75 mmHg. At each infusion rate of vasopressin, data on systemic hemodynamics, jejunal mucosal perfusion, jejunal mucosal hematocrit and red blood cell velocity (laser Doppler flowmetry) as well as gastric‐arterial p CO 2 gradient (gastric tonometry) and splanchnic oxygen and lactate extraction (hepatic vein catheter) were obtained. Results: The cardiac index, stroke volume index and systemic oxygen delivery decreased and systemic vascular resistance and systemic oxygen extraction increased significantly, while the heart rate or global oxygen consumption did not change with increasing vasopressin dose. Jejunal mucosal perfusion decreased and the arterial‐gastric‐mucosal p CO 2 gradient increased, while splanchnic oxygen or lactate extraction or mixed venous–hepatic venous oxygen saturation gradient were not affected by increasing infusion rates of vasopressin. Conclusions: Infusion of low to moderate doses of vasopressin in patients with norepinephrine‐dependent vasodilatory shock after cardiac surgery induces an intestinal and gastric mucosal vasoconstriction.
2002-10-08 | Cardiac performance during vasopressin infusion in postcardiotomy shock.
Arginine-vasopressin (AVP) might be a potent vasopressor agent in catecholamine-resistant postcardiotomy shock. However, its use remains experimental because of considerations about deleterious effects on the heart. We report on the effects of continuous AVP-infusion on cardiac performance, biomarkers of myocardial ischemia, and systemic hemodynamics in catecholamine-resistant postcardiotomy shock. Retrospective study. Twenty-one-bed general and surgical intensive care unit. Forty-one patients with catecholamine-resistant postcardiotomy shock. Continuous infusion of AVP. Heart rate (HR), heart rhythm, mean arterial pressure (MAP), central venous pressure, mean pulmonary arterial pressure, cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR) as well as milrinone and norepinephrine requirements were collected before and 1, 4, 12, 24, and 48 h after start of AVP infusion. Creatine kinase MB and troponin-I serum concentrations were measured daily. During AVP administration we observed a significant decrease in HR (-14.8%), milrinone (-17.5%), and norepinephrine requirements (-54.9%) as well as biomarkers of cardiac ischemia and a significant increase in LVSWI (+46.2%), MAP (+41.8%) and SVR (+60%). CI and SVI remained unchanged. Forty-five percent of postoperative new-onset tachyarrhythmias (TA) converted into sinus rhythm during AVP infusion. AVP was devoid of adverse effects on the heart in these patients with catecholamine-resistant postcardiotomy shock. The significant reduction in HR, vasopressor, and inotropic support suggest a substantial improvement in myocardial performance. These findings are supported by a significant decrease of cardiac enzymes and cardioversion of TA into sinus rhythm in 45.5% of patients with new-onset TA.
small molecules
2026-04-14 | Bleeding and thrombotic events during micro-axial flow pump support: A European multicenter cohort study.
BACKGROUND: Bleeding and thrombosis are major complications of micro-axial flow pump (mAFP) support in cardiogenic shock (CS), yet contemporary data on their incidence, temporal trends, and prognostic impact remain unclear. METHODS: We retrospectively analyzed patients supported with mAFP between 2010 and 2023 across eleven high-volume European centers. Bleeding and thrombotic events during support were adjudicated and normalized to annual implant volumes. Kaplan–Meier analysis assessed 180-day survival, and multivariable logistic regression identified independent predictors of bleeding and thrombosis. RESULTS: Among 1,043 patients (61% acute myocardial infarction related CS), Impella CP was used in 72% and Impella 5 in 28%. Overall, 503 patients (48%) experienced ≥ 1 event: 252 bleeding only, 149 thrombosis only, and 102 both. Independent predictors of bleeding were post-cardiotomy CS (OR 2.64; 95% CI, 1.41–4.96; p = .003), Acute myocardial infarction related CS (AMICS) (OR 2.27; 95% CI, 1.38–3.74; p = .001), V-A ECMO unloading indication (OR 1.65; 95% CI, 1.14–2.39; p = .008) and renal replacement therapy at implantation (OR 1.56; 95% CI, 1.08–2.27; P = .019). Predictors of thrombosis were prior stroke (OR 2.51; 95% CI 1.40–4.51), AMI-CS (OR 2.06; 95% CI 1.42–3.00), and mAFP unloading with V-A ECMO (OR 2.03; 95% CI 1.38–2.98). Bleeding (OR 1.38; 95% CI 1.02–1.87) and thrombosis (OR 2.10; 95% CI 1.53–2.88) were independently associated with higher 180-day mortality. CONCLUSIONS: In this large European mAFP cohort, bleeding and thrombotic events were frequent and associated with mortality and adverse outcomes. Their distinct risk profiles support individualized prevention strategies and underscore the need for prospective randomized trials comparing anticoagulation regimens in risk-stratified patients.
2025-04-04 | Does Levosimendan hasten veno-arterial ECMO weaning? A propensity score matching analysis.
Preliminary evidence from small, single-center studies suggests levosimendan may improve the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with cardiogenic shock. However, the literature is limited and presents conflicting results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to successful ECMO weaning, using a pragmatic and rigorous definition of successful VA-ECMO weaning in patients with potential for cardiac function recovery. A retrospective bicentric study over 6 years was conducted, including patients who received levosimendan during their ECMO course. Patients with post-cardiotomy cardiogenic shock or end-stage chronic heart failure were excluded. Patients receiving levosimendan while on VA-ECMO were matched to those not receiving levosimendan during the same period, based on pre-specified variables and time from ECMO initiation. The primary endpoint was successful VA-ECMO weaning, defined as survival without death, heart transplantation, or LVAD within 30 days after VA-ECMO withdrawal. Over the study period, 320 patients treated with VA-ECMO for refractory cardiogenic shock were included, of whom 68 received levosimendan during their ECMO course. Propensity score matching yielded 47 unique pairs of patients with comparable characteristics. After matching, successful ECMO weaning was achieved in 16 out of 47 patients (34%) in the no-levosimendan group and 21 out of 47 patients (45%) in the levosimendan group (sHR, 1.45 [95% CI, 0.77-2.70]; P = 0.25). Similarly, there were no significant differences between the groups in terms of bridge-to-heart transplant, LVAD, or death. Left ventricular ejection fraction and aortic velocity time integral improved significantly after levosimendan in all patients, regardless of their VA-ECMO weaning status. In patients with non-postoperative cardiogenic shock supported by peripheral VA-ECMO, levosimendan was not associated with increased rates of successful VA-ECMO weaning or improved 30-day and 6-month bridge-free survival. Results from double-blinded randomized controlled trials are urgently needed to clarify the effectiveness and optimal timing of levosimendan in this specific population.
2024-08-02 | The effect of high-dose selenium on mortality and postoperative organ dysfunction in post-cardiotomy cardiogenic shock patients supported with mechanical circulatory support - A post-hoc analysis of the SUSTAIN CSX trial.
Cardiac surgery, post-cardiotomy cardiogenic shock (PCCS), and temporary mechanical circulatory support (tMCS) provoke substantial inflammation. We therefore investigated whether a selenium-based, anti-inflammatory strategy would benefit PCCS patients treated with tMCS in a post-hoc analysis of the sustain CSX trial. Post-hoc analysis of patients receiving tMCS for PCCS in the Sustain CSX trial, which investigated the effects of high-dose selenium on postoperative organ dysfunction in cardiac surgery patients. duration of tMCS therapy. postoperative organ dysfunction and 30-day mortality. Thirty-nine patients were treated with tMCS for PCCS. There was no difference in the median duration of tMCS between the selenium and the placebo group (3 days [IQR: 1-6] vs. 2 days [IQR: 1-7], p = 0.52). Median dialysis duration was longer in the selenium group (1.5 days [0-21.8] vs. 0 days [0-1.8], p = 0.048). There was no difference in 30-day mortality (53% vs. 41%, OR 1.44, 95% CI 0.32-6.47, p = 0.62). In this explorative study, a perioperative high-dose selenium-supplementation did not show beneficial effects on organ dysfunctions and mortality rates in patients with PCCS receiving tMCS.
2024-02-20 | Thrombosis of Prosthetic Tricuspid Valve During Veno-Arterial Extracorporeal Membrane Oxygenation Support: A Case Report
Extracorporeal membrane oxygenation (ECMO) is frequently used for severe postcardiotomy cardiogenic shock in patients with bioprosthetic valves. Acute prosthetic valve thrombosis (PVT) is a rare complication after valve replacement surgery and significantly increases morbidity and mortality. Patients who develop PVT on ECMO could significantly influence the long-term durability of the bioprosthetic valves. However, previous studies only analyzed risk factor and treatment of the mitral valve thrombosis during ECMO support. The mechanism of thrombosis on the tricuspid valve was still unknown. Here we describe the symptoms and treatment of a valve replacement patient who developed bioprosthetic tricuspid valve thrombosis during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Meanwhile, the patient’s mechanical prosthetic mitral valve functioned normally. An emergency re-do tricuspid prosthesis replacement was performed, and the patient finally developed the successful decannulation. At 6 months follow-up, the patient showed asymptomatic and had a reasonable quality of life. The pathophysiology of tricuspid valve thrombosis may be different from the left heart. Our case highlights that the risk of thrombosis associated with a prosthesis in the tricuspid position can be even higher in the setting of VA-ECMO support. In such patients, promoting forward blood flow across the prosthesis and improving levels of anticoagulation may be particularly important.
2023-08-01 | Pulmonary Vasodilator and Inodilator Drugs in Cardiac Surgery: A Systematic Review With Bayesian Network Meta-Analysis
Objective. We performed a systematic review to evaluate the effect of pharmacological therapy of pulmonary hypertension in the perioperative setting of elective cardiac surgery (PROSPERO CRD42023321041).Design Systematic review of randomized controlled trials with a Bayesian network meta-analysis.Setting We searched on biomedical databases randomized controlled trials on the perioperative use of inodilators and pulmonary vasodilators in adult cardiac surgery, with in-hospital mortality as the primary outcome and duration of ventilation, length of stay in the intensive care unit, stage 3 acute kidney injury, cardiogenic shock requiring mechanical support, and change in mean pulmonary artery pressure as secondary outcomes.Participants Twenty-eight studies randomizing 1879 patients were included.Interventions Catecholamines and non-catecholamine inodilators, arterial pulmonary vasodilators, vasodilators or their combination were considered eligible interventions compared to placebo or standard care.Measurements and Main Results Ten studies reported in-hospital mortality and assigned 855 patients to 12 different interventions. Only inhaled prostacyclin use was supported by a statistically discernible improvement in mortality, with a number-need-to-treat estimate of at least 3.3, but a wide credible interval (RR 1.26*10−17-0.7). Inhaled prostacyclin and nitric oxide were associated with a reduction in ICU stay, while none of the included interventions reached a statistically evident difference in comparison to usual care or placebo in the other secondary clinical outcomes.Conclusions inhaled prostacyclin was the only pharmacological interventions which use is supported by a statistically discernible improvement in mortality in perioperative cardiac surgery setting as treatment of pulmonary hypertension. However, available evidence has significant limitations, mainly the low number of events and imprecision.
cell therapies
2026-04-23 | Postcardiotomy veno-arterial membrane oxygenation as a bridge to heart replacement therapies.
Data on the outcome of veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) support as a bridge to replacement therapies are scarce. We investigated the outcome of V-A-ECMO support after adult cardiac surgery as a bridge to ventricular assist device (VAD) implantation and/or heart transplantation. This is a retrospective, multicenter study recruiting patients who underwent heart transplantation or VAD implantation immediately after postcardiotomy V-A-ECMO for persistent heart failure at 14 European centers of cardiac transplantation from 2010 to 2024. Ninety-four consecutive patients were treated at 14 European centers of cardiac transplantation from 2010 to 2024. In-hospital mortality after replacement therapy was 31.9%, while it was 35.2% (19/54 patients) after primary VAD implantation and 27.5% (11/40 patients) after primary heart transplantation (p = 0.429) after V-A-ECMO. Five-year all-cause mortality of the overall series was 52.4%. Five-year mortality was 66.0% after primary VAD and 32.7% after primary heart transplantation (adjusted HR 0.420, 95%CI 0.199-0.885). Sixty-four patients underwent heart transplantation any time after V-A-ECMO support and had a 5-year mortality rate of 34.9%, while it was 83.9% among 32 patients who received VAD support only (p < 0.0001). The present findings support a bridge policy to heart replacement in selected postcardiotomy V-A-ECMO patients. Primary heart transplantation after V-A-ECMO support may be associated with better survival. The small size of this series and its results suggest that a larger study is needed to confirm these findings and could strengthen external validity and enhance the applicability of the results across different healthcare settings.
2026-03-28 | Design and rationale of the Impella®-protected cardiac surgery trial (IMPACT): A multicenter, single-arm pilot study in high-risk cardiac surgery patients.
Cardiac surgery patients with severe preoperative left ventricular (LV) dysfunction are at high risk for poor postoperative outcomes including prolonged ventilation, renal failure and post-cardiotomy cardiogenic shock (PCCS). Mortality and morbidity remain high for patients who develop PCCS, thus mandating the availability of more effective prophylactic and treatment options. The Impella®-Protected Cardiac Surgery Trial (IMPACT) is a prospective, multicenter, single-arm pilot study assessing Impella 5.5® use prior to weaning from cardiopulmonary bypass in high-risk cardiac surgery patients. Key inclusion criteria are a baseline LV ejection fraction ≤25% or ≤35% with significant mitral regurgitation and planned mitral valve replacement or repair (MVR), and undergoing planned, on-pump isolated coronary artery bypass grafting, MVR, aortic valve replacement, or a combination of these with or without tricuspid valve replacement. The primary effectiveness endpoint is the rate of PCCF at hospital discharge. The primary safety endpoint is the composite of all-cause mortality, stroke and new requirement for renal replacement therapy evaluated through 90 days post-operation. Additional secondary endpoints include hospital and ICU lengths of stay, vasoactive-inotropic score, duration of mechanical ventilation and cardiovascular mortality. A concurrent registry will aim to collect data on patients not approached for study enrollment or who do not meet all inclusion and exclusion criteria. IMPACT results will provide data on trial and technique feasibility, patient selection criteria and aid in informing future trial designs. ClinicalTrials.gov, NCT05529654, https://clinicaltrials.gov/study/NCT05529654.
2025-12-16 | Survival against the ODDS-ESMO in postcardiotomy cardiogenic shock
Introduction. Postcardiotomy cardiogenic shock is a severe complication of cardiac surgery, often requiring mechanical circulatory support and associated with high mortality. We present a case illustrating the complex management of biventricular failure, atrial fibrillation, and ischemic cardiomyopathy from emergency admission to surgical recovery. Case Report. A 67-year-old man presented with dyspnoea, hypotension, and facial and peripheral oedema. Echocardiography revealed severe biventricular dysfunction with a left ventricular ejection fraction of 15%, right ventricular failure, and severe tricuspid regurgitation. On admission, he developed atrial fibrillation, managed with inotropes, diuretics, and cautious rate control. Diagnostic work-up revealed multivessel coronary and significant carotid artery disease. The patient underwent urgent triple coronary artery bypass grafting, tricuspid annuloplasty, left carotid endarterectomy, box pulmonary vein isolation, and left atrial appendage occlusion. Intraoperatively, refractory cardiogenic shock necessitated veno-arterial extracorporeal membrane oxygenation with left ventricular venting. Mechanical circulatory support was successfully weaned after three days as cardiac function improved. Postoperative recovery was complicated by Clostridioides difficile enterocolitis and fungal pneumonia. He was discharged on postoperative day 36, and at six months remained clinically stable with improved functional capacity. Conclusion. This case underscores the importance of a multidisciplinary approach in managing complex cardiac patients. Early hemodynamic assessment, individualized therapy, and timely initiation of extracorporeal membrane oxygenation were critical to survival. In this setting, extracorporeal membrane oxygenation proved to be an effective bridge to recovery, emphasizing its value in select high-risk cases of postcardiotomy cardiogenic shock.
2025-12-15 | Right Ventricular-Pulmonary Artery Cannulation in Right Ventricular Failure: An Updated Narrative Review.
Right ventricular (RV) failure is a life-threatening condition contributing to morbidity and mortality in several pathological conditions, particularly in postcardiotomy shock, advanced heart failure, pulmonary embolism, and severe respiratory disease. Temporary mechanical circulatory support has gained increasing attention in refractory conditions, with dual-lumen cannulation strategies specifically designed to facilitate such a support modality, decompress the right atrium or ventricle while preserving antegrade pulmonary blood flow and allowing, in case of need, concomitant RV and respiratory support. A narrative review was conducted through PubMed, identifying English-language, peer-reviewed articles published between January 2011 and September 2025. The search combined the term "dual lumen pulmonary artery cannula" with related keywords including "pulmonary artery cannulation", "right atrium to pulmonary artery cannulation", "percutaneous right ventricular assist", "temporary RVAD", "oxygenated RVAD", and "right-sided mechanical circulatory support". Eligible studies included case reports, series, cohort studies, and reviews. Structured institutional resources were also evaluated to complement evidence with practical insights. Twenty-one publications were identified, of which 13 met the inclusion criteria. Reports consistently highlighted the rationale for RV unloading, clinical indications across postcardiotomy shock, LVAD-related dysfunction, pulmonary embolism, and ARDS, and described standardized insertion through the right internal jugular vein with imaging guidance. Complications included cannula malposition, thromboembolism, bleeding, and infection, while support durations typically ranged from 7 to 14 days, although its incidence is lower with jugular access compared with femoral approaches and open chest procedures. Weaning rates ranged between 40% and 70% of cases, with early initiation of support associated with improved survival. Dual-lumen right atrium/ventricle-to-pulmonary artery cannulation represents a feasible and physiologically advantageous option for temporary isolated RV or concomitant RV and respiratory support. Current evidence, however, is limited to small observational studies, underscoring the need for multicenter registries, uniform nomenclature, and prospective trials to establish standardized protocols and clarify its role relative to alternative right-sided support strategies.
2024-09-27 | Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock.
Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.
proteins
2022-07-19 | Recombinant human brain natriuretic peptide ameliorates venous return function in congestive heart failure.
Recombinant human brain natriuretic peptide (rh-BNP) is commonly used as a decongestive therapy. This study aimed to investigate the instant effects of rh-BNP on cardiac output and venous return function in post-cardiotomy patients with congestive heart failure (CHF). Twenty-four post-cardiotomy heart failure patients were enrolled and received a standard loading dose of rh-BNP. Haemodynamic monitoring was performed via a pulmonary artery catheter before and after the administration of rh-BNP. The cardiac output and venous return functions were estimated by depicting Frank-Starling and Guyton curves. After rh-BNP infusion, variables reflecting cardiac congestion and venous return function, such as pulmonary artery wedge pressure, mean systemic filling pressure (Pmsf) and venous return resistance index (VRRI), reduced from 15 ± 3 to 13 ± 3 mmHg, from 32 ± 7 to 28 ± 7 mmHg and from 6.7 ± 2.6 to 5.7 ± 1.8 mmHg min m2 /L, respectively. Meanwhile, cardiac index, stroke volume index, and the cardiac output function curve remained unchanged per se. The decline in Pmsf [-13% (-22% to -8%)] and VRRI [-12% (-25% to -5%)] was much greater than that in the systemic vascular resistance index [-7% (-14% to 0%)]. In the subgroup analysis of reduced ejection fraction (<40%) patients, the aforementioned changes were more significant. rh-BNP might ameliorate venous return rather than cardiac output function in post-cardiotomy CHF patients.
2019-04-09 | Terlipressin versus norepinephrine to prevent milrinone-induced systemic vascular hypotension in cardiac surgery patient with pulmonary hypertension
Milrinone at inotropic doses requires the addition of a vasoconstrictive drug. We hypothesized that terlipressin use could selectively recover the systemic vascular hypotension induced by milrinone without increasing the pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) as norepinephrine in cardiac surgery patients.Patients with pulmonary hypertension were enrolled in this study. At the start of rewarming a milrinone 25 μg/kg bolus over 10 min followed by infusion at the rate of 0.25 μg/kg/min. Just after the loading dose of milrinone, the patients were randomized to receive norepinephrine infusion at a dose of 0.1 μg/kg/min (norepinephrine group) or terlipressin infusion at a dose of 2 μg/kg/h (terlipressin group). Heart rate, mean arterial blood pressure (MAP), central venous pressure, MPAP, systemic vascular resistance (SVR), PVR, cardiac output were measured after induction of anesthesia, after loading dose of milrinone, during skin closure, and in the intensive care unit till 24 h.Milrinone decreased MAP (from 79.56 ± 4.5 to 55.21 ± 2.1 and from 78.46 ± 3.3 to 54.11 ± 1.1) and decreased the MPAP (from 59.5 ± 3.5 to 25.4 ± 2.6 and from 61.3 ± 5.2 to 25.1 ± 2.3) in both groups. After norepinephrine, there was an increase in the MAP which is comparable to terlipressin group (P > 0.05). Terlipressin group shows a significant lower MPAP than norepinephrine group (24.5 ± 1.4 at skin closure vs. 43.3 ± 2.1, than 20.3 ± 2.1 at 24 h vs. 39.8 ± 3.8 postoperatively). There is a comparable increase in the SVR in both group, PVR showed a significant increase in the norepinephrine group compared to the terlipressin group (240.5 ± 23 vs. 140.6 ± 13 at skin closure than 190.3 ± 32 vs. 120.3 ± 10 at 24 h postoperatively).The use of terlipressin after milrinone will reverse systemic hypotension with lesser effect on the pulmonary artery pressure.
2016-12-14 | Arginine–vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function
Abstract We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine–vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine–vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as “responders” if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine–vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1–26.9), and the median weight was 4.3 kg (3.2–5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the “target” arginine–vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine–vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.
2009-02-23 | Vasopressin decreases intestinal mucosal perfusion: a clinical study on cardiac surgery patients in vasodilatory shock
Background: Low to moderate doses of vasopressin have been used in the treatment of cathecholamine‐dependent vasodilatory shock in sepsis or after cardiac surgery. We evaluated the effects of vasopressin on jejunal mucosal perfusion, gastric‐arterial p CO 2 gradient and the global splanchnic oxygen demand/supply relationship in patients with vasodilatory shock after cardiac surgery. Methods: Eight mechanically ventilated patients, dependent on norepinephrine to maintain mean arterial pressure (MAP) ≥60 mmHg because of septic/post‐cardiotomy vasodilatory shock and multiple organ failure after cardiac surgery, were included. Vasopressin was sequentially infused at 1.2, 2.4 and 4.8 U/h for 30‐min periods. Norepinephrine was simultaneously decreased to maintain MAP at 75 mmHg. At each infusion rate of vasopressin, data on systemic hemodynamics, jejunal mucosal perfusion, jejunal mucosal hematocrit and red blood cell velocity (laser Doppler flowmetry) as well as gastric‐arterial p CO 2 gradient (gastric tonometry) and splanchnic oxygen and lactate extraction (hepatic vein catheter) were obtained. Results: The cardiac index, stroke volume index and systemic oxygen delivery decreased and systemic vascular resistance and systemic oxygen extraction increased significantly, while the heart rate or global oxygen consumption did not change with increasing vasopressin dose. Jejunal mucosal perfusion decreased and the arterial‐gastric‐mucosal p CO 2 gradient increased, while splanchnic oxygen or lactate extraction or mixed venous–hepatic venous oxygen saturation gradient were not affected by increasing infusion rates of vasopressin. Conclusions: Infusion of low to moderate doses of vasopressin in patients with norepinephrine‐dependent vasodilatory shock after cardiac surgery induces an intestinal and gastric mucosal vasoconstriction.
2002-10-08 | Cardiac performance during vasopressin infusion in postcardiotomy shock.
Arginine-vasopressin (AVP) might be a potent vasopressor agent in catecholamine-resistant postcardiotomy shock. However, its use remains experimental because of considerations about deleterious effects on the heart. We report on the effects of continuous AVP-infusion on cardiac performance, biomarkers of myocardial ischemia, and systemic hemodynamics in catecholamine-resistant postcardiotomy shock. Retrospective study. Twenty-one-bed general and surgical intensive care unit. Forty-one patients with catecholamine-resistant postcardiotomy shock. Continuous infusion of AVP. Heart rate (HR), heart rhythm, mean arterial pressure (MAP), central venous pressure, mean pulmonary arterial pressure, cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR) as well as milrinone and norepinephrine requirements were collected before and 1, 4, 12, 24, and 48 h after start of AVP infusion. Creatine kinase MB and troponin-I serum concentrations were measured daily. During AVP administration we observed a significant decrease in HR (-14.8%), milrinone (-17.5%), and norepinephrine requirements (-54.9%) as well as biomarkers of cardiac ischemia and a significant increase in LVSWI (+46.2%), MAP (+41.8%) and SVR (+60%). CI and SVI remained unchanged. Forty-five percent of postoperative new-onset tachyarrhythmias (TA) converted into sinus rhythm during AVP infusion. AVP was devoid of adverse effects on the heart in these patients with catecholamine-resistant postcardiotomy shock. The significant reduction in HR, vasopressor, and inotropic support suggest a substantial improvement in myocardial performance. These findings are supported by a significant decrease of cardiac enzymes and cardioversion of TA into sinus rhythm in 45.5% of patients with new-onset TA.
small molecules
2026-04-14 | Bleeding and thrombotic events during micro-axial flow pump support: A European multicenter cohort study.
BACKGROUND: Bleeding and thrombosis are major complications of micro-axial flow pump (mAFP) support in cardiogenic shock (CS), yet contemporary data on their incidence, temporal trends, and prognostic impact remain unclear. METHODS: We retrospectively analyzed patients supported with mAFP between 2010 and 2023 across eleven high-volume European centers. Bleeding and thrombotic events during support were adjudicated and normalized to annual implant volumes. Kaplan–Meier analysis assessed 180-day survival, and multivariable logistic regression identified independent predictors of bleeding and thrombosis. RESULTS: Among 1,043 patients (61% acute myocardial infarction related CS), Impella CP was used in 72% and Impella 5 in 28%. Overall, 503 patients (48%) experienced ≥ 1 event: 252 bleeding only, 149 thrombosis only, and 102 both. Independent predictors of bleeding were post-cardiotomy CS (OR 2.64; 95% CI, 1.41–4.96; p = .003), Acute myocardial infarction related CS (AMICS) (OR 2.27; 95% CI, 1.38–3.74; p = .001), V-A ECMO unloading indication (OR 1.65; 95% CI, 1.14–2.39; p = .008) and renal replacement therapy at implantation (OR 1.56; 95% CI, 1.08–2.27; P = .019). Predictors of thrombosis were prior stroke (OR 2.51; 95% CI 1.40–4.51), AMI-CS (OR 2.06; 95% CI 1.42–3.00), and mAFP unloading with V-A ECMO (OR 2.03; 95% CI 1.38–2.98). Bleeding (OR 1.38; 95% CI 1.02–1.87) and thrombosis (OR 2.10; 95% CI 1.53–2.88) were independently associated with higher 180-day mortality. CONCLUSIONS: In this large European mAFP cohort, bleeding and thrombotic events were frequent and associated with mortality and adverse outcomes. Their distinct risk profiles support individualized prevention strategies and underscore the need for prospective randomized trials comparing anticoagulation regimens in risk-stratified patients.
2025-04-04 | Does Levosimendan hasten veno-arterial ECMO weaning? A propensity score matching analysis.
Preliminary evidence from small, single-center studies suggests levosimendan may improve the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with cardiogenic shock. However, the literature is limited and presents conflicting results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to successful ECMO weaning, using a pragmatic and rigorous definition of successful VA-ECMO weaning in patients with potential for cardiac function recovery. A retrospective bicentric study over 6 years was conducted, including patients who received levosimendan during their ECMO course. Patients with post-cardiotomy cardiogenic shock or end-stage chronic heart failure were excluded. Patients receiving levosimendan while on VA-ECMO were matched to those not receiving levosimendan during the same period, based on pre-specified variables and time from ECMO initiation. The primary endpoint was successful VA-ECMO weaning, defined as survival without death, heart transplantation, or LVAD within 30 days after VA-ECMO withdrawal. Over the study period, 320 patients treated with VA-ECMO for refractory cardiogenic shock were included, of whom 68 received levosimendan during their ECMO course. Propensity score matching yielded 47 unique pairs of patients with comparable characteristics. After matching, successful ECMO weaning was achieved in 16 out of 47 patients (34%) in the no-levosimendan group and 21 out of 47 patients (45%) in the levosimendan group (sHR, 1.45 [95% CI, 0.77-2.70]; P = 0.25). Similarly, there were no significant differences between the groups in terms of bridge-to-heart transplant, LVAD, or death. Left ventricular ejection fraction and aortic velocity time integral improved significantly after levosimendan in all patients, regardless of their VA-ECMO weaning status. In patients with non-postoperative cardiogenic shock supported by peripheral VA-ECMO, levosimendan was not associated with increased rates of successful VA-ECMO weaning or improved 30-day and 6-month bridge-free survival. Results from double-blinded randomized controlled trials are urgently needed to clarify the effectiveness and optimal timing of levosimendan in this specific population.
2024-08-02 | The effect of high-dose selenium on mortality and postoperative organ dysfunction in post-cardiotomy cardiogenic shock patients supported with mechanical circulatory support - A post-hoc analysis of the SUSTAIN CSX trial.
Cardiac surgery, post-cardiotomy cardiogenic shock (PCCS), and temporary mechanical circulatory support (tMCS) provoke substantial inflammation. We therefore investigated whether a selenium-based, anti-inflammatory strategy would benefit PCCS patients treated with tMCS in a post-hoc analysis of the sustain CSX trial. Post-hoc analysis of patients receiving tMCS for PCCS in the Sustain CSX trial, which investigated the effects of high-dose selenium on postoperative organ dysfunction in cardiac surgery patients. duration of tMCS therapy. postoperative organ dysfunction and 30-day mortality. Thirty-nine patients were treated with tMCS for PCCS. There was no difference in the median duration of tMCS between the selenium and the placebo group (3 days [IQR: 1-6] vs. 2 days [IQR: 1-7], p = 0.52). Median dialysis duration was longer in the selenium group (1.5 days [0-21.8] vs. 0 days [0-1.8], p = 0.048). There was no difference in 30-day mortality (53% vs. 41%, OR 1.44, 95% CI 0.32-6.47, p = 0.62). In this explorative study, a perioperative high-dose selenium-supplementation did not show beneficial effects on organ dysfunctions and mortality rates in patients with PCCS receiving tMCS.
2024-02-20 | Thrombosis of Prosthetic Tricuspid Valve During Veno-Arterial Extracorporeal Membrane Oxygenation Support: A Case Report
Extracorporeal membrane oxygenation (ECMO) is frequently used for severe postcardiotomy cardiogenic shock in patients with bioprosthetic valves. Acute prosthetic valve thrombosis (PVT) is a rare complication after valve replacement surgery and significantly increases morbidity and mortality. Patients who develop PVT on ECMO could significantly influence the long-term durability of the bioprosthetic valves. However, previous studies only analyzed risk factor and treatment of the mitral valve thrombosis during ECMO support. The mechanism of thrombosis on the tricuspid valve was still unknown. Here we describe the symptoms and treatment of a valve replacement patient who developed bioprosthetic tricuspid valve thrombosis during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Meanwhile, the patient’s mechanical prosthetic mitral valve functioned normally. An emergency re-do tricuspid prosthesis replacement was performed, and the patient finally developed the successful decannulation. At 6 months follow-up, the patient showed asymptomatic and had a reasonable quality of life. The pathophysiology of tricuspid valve thrombosis may be different from the left heart. Our case highlights that the risk of thrombosis associated with a prosthesis in the tricuspid position can be even higher in the setting of VA-ECMO support. In such patients, promoting forward blood flow across the prosthesis and improving levels of anticoagulation may be particularly important.
2023-08-01 | Pulmonary Vasodilator and Inodilator Drugs in Cardiac Surgery: A Systematic Review With Bayesian Network Meta-Analysis
Objective. We performed a systematic review to evaluate the effect of pharmacological therapy of pulmonary hypertension in the perioperative setting of elective cardiac surgery (PROSPERO CRD42023321041).Design Systematic review of randomized controlled trials with a Bayesian network meta-analysis.Setting We searched on biomedical databases randomized controlled trials on the perioperative use of inodilators and pulmonary vasodilators in adult cardiac surgery, with in-hospital mortality as the primary outcome and duration of ventilation, length of stay in the intensive care unit, stage 3 acute kidney injury, cardiogenic shock requiring mechanical support, and change in mean pulmonary artery pressure as secondary outcomes.Participants Twenty-eight studies randomizing 1879 patients were included.Interventions Catecholamines and non-catecholamine inodilators, arterial pulmonary vasodilators, vasodilators or their combination were considered eligible interventions compared to placebo or standard care.Measurements and Main Results Ten studies reported in-hospital mortality and assigned 855 patients to 12 different interventions. Only inhaled prostacyclin use was supported by a statistically discernible improvement in mortality, with a number-need-to-treat estimate of at least 3.3, but a wide credible interval (RR 1.26*10−17-0.7). Inhaled prostacyclin and nitric oxide were associated with a reduction in ICU stay, while none of the included interventions reached a statistically evident difference in comparison to usual care or placebo in the other secondary clinical outcomes.Conclusions inhaled prostacyclin was the only pharmacological interventions which use is supported by a statistically discernible improvement in mortality in perioperative cardiac surgery setting as treatment of pulmonary hypertension. However, available evidence has significant limitations, mainly the low number of events and imprecision.
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Drug Discovery Landscape
1 orphan drug designation for Postcardiotomy right ventricular failure.
1 orphan drug designation for Postcardiotomy right ventricular failure.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
Sildenafil citrate | small molecules | EMA | 2010-11-26 | — | Pfizer Europe MA EEIG |
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