Ventricular Mechanical Support

In this issue of the Argentine Journal of Cardiology, Bertolotti et al. from the Hospital Universitario Fundacion Favaloro (1) present excellent results with the Levitronix CentriMag® centrifugal flow pump in patients with cardiogenic shock. With this centrifugal flow pump, whose magnetically levitated rotor is the only mobile piece, femoral arteriovenous implantation with extracorporeal membrane oxygenator (ECMO) or left atrioaortic or right atriopulmonary implantation can be performed. Its clinical application has attracted great interest: simple and easily transportable management that represents an excellent alternative to hospitals without cardiac transplantation program, univentricular or biventricular support, high flows reaching up to 10 L / min, low hemolysis, low thromboembolism, albeit requiring anticoagulation, and low cost. (2) In my personal experience, out of 102 assist device implantations during the 1987-2011 period, 32 were with Levitronix CentriMag® pump, becoming the most implanted assist device since 2006. Although authorized as Class I support up to 30 days, we also use it as Class II support, with pump replacement every four weeks. The results reported by Bertolotti et al. (1) show 40% mortality. It is an excellent result and it would be more representative to describe 60% survival since all the patients had refractory cardiogenic shock in INTERMACS 1, despite inotropic support; therefore, survival without support would have been null. Is support justified considering the price and that the healthcare system cannot provide unlimited benefits with limited resources? Lack of survival in this group of patients without support justifies the treatment. Moreover, the reduced price of CentriMag® assist device compared to other Class II and III medical assist devices is validated as bridge to decision in patients requiring longterm support, gaining precious time to assess patient viability. Is the cost-benefit and cost-utility ratio justified, especially as a conclusive therapy? Any new treatment is asked to improve survival and quality of life.