Advanced mechanical circulatory support for refractory cardiogenic shock after cardiac surgery: An eleven-year experience in Edinburgh

Background/Introduction Post-cardiotomy cardiogenic shock (PCCS) occurs in 2-6% of patients undergoing surgical revascularization or valvular surgery. Approximately 0.5-1.5% of patients are refractory to maximal inotropic and intra-aortic balloon counter pulsation (IABP) support. Refractory PCCS leads to rapid multi-organ dysfunction syndrome and is an almost universally fatal clinical state without advanced mechanical circulatory support (AMCS) i.e. extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). However, the associated major complications and cost related to such complex devices has led to centralization of such valuable services to only a few UK centers.