Catheter-Oriented Unloading and Recovery With a Left Ventricular Assist Gear: Efficacy in Post Cardiotomy Cardiogenic Shock (COURAGE)

Inclusion Criteria:

• 18≤Age≤80, any sex.
• Failure to wean from CPB or refractory cardiogenic shock after cardiac surgery.

Failure to wean from CPB is defined as failed to discontinue CPB or post-weaning CI <2.2L/min/m2 + PCWP >15mmHg, despite optimal pre-weaning management and receiving at least one high dose inotrope.

Refractory cardiogenic shock is defined as a condition that occurs despite adequate fluid status and meets all the following criteria:

① CI<2.2L/min/m2 + PCWP>15mmHg despite receiving at least one high dose inotrope or IABP; OR SBP <80mmHg or MAP<50mmHg despite receiving at least one high dose intrope + high dose norepinephrine or IABP.

② Presence of at least one signs indicating hypoperfusion: decreased mentation; cold, clammy, ashen or cyanotic extremities or skin or livedo reticularis; urine output<30ml/h or 0.5ml/kg/h; or lactate>2mmol/L or metabolic acidosis.

- Patient has signed the informed consent form.

Exclusion Criteria:

• Body surface area>2.5m2.
• Presence of any cardiac assist device (other than an IABP).
• Right ventricular failure.
• Evidence of any vascular disease or anatomy precluding placement or deployment of the device (e.g. severely calcified vessel).
• Evidence of ventricular thrombus.
• Moderate or severe aortic valve insufficiency/stenosis, or severe aortic valve calcification.
• Presence of mechanical aortic valve or cardiac contractile device.
• Obstructive, hypertrophic cardiomyopathy.
• Presence of uncorrected ventricular septal defect, atrial septal defect or patent foramen ovale.
• Mechanical manifestation of AMI (e.g. ventricular septal rupture, papillary muscle rupture, ventricular rupture).
• Any hematological disorder causing fragility of blood vessel or hemolysis.
• Known allergy or intolerant to heparin.
• Presence or suspicion of active systemic infection.
• Cardiopulmonary resuscitative maneuver lasting longer than 20 minutes before device placement.
• Sustained or non-sustained ventricular tachycardia or ventricular fibrillation unresponsive to medical therapy.
• Severe hepatic dysfunction, renal failure or severe respiratory failure
• Pregnant or lactating female.
• Concomitant enrollment in another investigational drug or device study where the primary endpoint has not yet been completed or that will clinically interfere with the endpoint of this investigation.
• Other conditions considered unsuitable for participating in this investigation by the investigators.