Bridge to Decision Using the Levitronix CentriMag Short-term Ventricular Assist Device Fabio De Robertis, MD, Paula Rogers, RGN, Mohammed Amrani, FRCS, PhD, Mario Petrou, FRCS, PhD, John R. Pepper, FRCS, Toufan Bahrami, FRCS, Gilles D. Dreyfus, FRCS, Asghar Khaghani, FRCS, and Emma J. Birks, MRCP, PhD Background: Ventricular assist devices are effective in severe end-stage cardiac failure but outcomes remain poor in critically ill patients. Cheaper and less invasive short-term devices have been used in this setting. We report our experience with the Levitronix CentriMag short-term ventricular assist device as a potential bridge prior to deciding whether a more expensive device should be used or whether transplantation should be undertaken. Methods: Since August 2003, 16 moribund patients (14 males; age 32.7  14.9 [range 16 to 62] years) have been supported with the CentriMag device as a “bridge to decision.” Twelve patients had an intra-aortic balloon pump pre-operatively, 13 had multi-organ failure, 11 had septic shock, and in 5 patients the neurologic status was uncertain at the time of insertion of the device. Results: Operative mortality was 18.7% (3 patients). Seven patients (43.7%) were reoperated for bleeding. The mean support duration was 46.9  32.3 (range 6 to 111) days. There were 2 late deaths during Levitronix utilization. Follow-up was 12.8  12.5 (range 0.6 to 43) months. Eleven patients (68.7%) are currently alive and well: 2 patients recovered and had the Levitronix device explanted; 6 patients were upgraded to a long-term device; and 3 patients were bridged directly to transplantation. The actuarial survival at 1, 6 and 12 months was 85.7%, 64.9% and 64.9%, respectively. There were no instances of device failure. Conclusions: The Levitronix device is effective in rescuing critically ill “moribund” patients and can provide an opportunity for low-cost support and optimization of their condition prior to deciding whether a more expensive device should be placed or if transplantation should be undertaken. Better candidate selection for further procedures can then be allowed. J Heart Lung Transplant 2008;27: 474 – 8. Copyright © 2008 by the International Society for Heart and Lung Transplantation. Ventricular assist devices (VADs) are now very effective in the treatment of severe end-stage cardiac failure. 1 However, despite improvements in the field of mechan- ical circulatory support (MCS) in the last few years, patients who present in a moribund state are difficult to deal with because of the presence of end-stage organ failure and the often uncertain neurologic status in ventilated patients. In these very critically ill patients the outcome remains poor. 2 Using short-term devices such as the Levitronix CentriMag VAD in this setting provides an opportunity for stabilizing the hemody- namic state of the patients and offers a chance to further assess their clinical condition. 3–10 We report our experience with the Levitronix CentriMag VAD in a cohort of extremely sick patients for whom mechanical support was used as a potential “bridge to decision” before deciding whether a more expensive device should be used or whether transplan- tation should be undertaken. METHODS Details of the CentriMag device, its implantation tech- nique and its clinical performance have been described previously. 6,7 Essentially, it is a single-use extracorpo- real centrifugal blood pump based on bearingless motor technology. The motor generates the magnetic bearing force that levitates the rotor in the pump housing and, at the same time, generates the torque to produce the unidirectional flow. After approval by the ethics com- mittee, from August 2003 to May 2007 at our institution we supported 55 patients with the CentriMag device. Informed consent was obtained from all conscious patients. In the unconscious cases, the medical team From the Department of Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Trust, Harefield, Mid- dlesex, UK. Submitted July 20, 2007; revised December 4, 2007; accepted January 24, 2008. Reprint requests: Emma Birks, MRCP, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex UB9 6JH, UK. Telephone: 00-44-1895-826511. Fax: 00-44-1895-826512. E-mail: e.birks@imperial. ac.uk. Copyright © 2008 by the International Society for Heart and Lung Transplantation. 1053-2498/08/$–see front matter. doi:10.1016/ j.healun.2008.01.027 474