PCCS & LCOS
What Is Postcardiotomy Cardiogenic Shock (PCCS) & Low Cardiac Output Syndrome (LCOS)?
Postcardiotomy cardiogenic shock (PCCS) is a rare but potentially life-threatening complication that can occur after cardiac surgery. The risks of PCCS can vary depending on a number of factors, including the patient's age, overall health, and the specific type of surgery performed.
“When patients are treated with CABG and intensive medical therapy [...], they are exposed to an early risk as a result of the surgical intervention.”1
Identifying the Early Hazard of Surgery - Risk Factors
Identifying certain risk factors that can contribute to PCCS/LCOS may inform the decision on treatment options.
Be Prepared for Patients Experiencing PCCS/LCOS
Consider Insertion of Impella® heart pump via axillary access
The patient is at risk for impaired cardiac function preoperatively according to SCAI A guidelines. The type of cardiosurgical procedure intended will play a role in determining the level of risk.
Patients with a history of significant reduced ejection fraction (EF) below 30%, re-operations, impaired kidney function, arrhythmias, or congestive heart failure (CHF) are at an increased risk for perioperative complications. Additionally, an increased EuroScore, which is used to predict the risk of mortality during cardiac surgery, can also indicate a higher risk for complications.
These patients might be candidates for PCCS and should be prepared to receive an Impella pump enabling an axillary access. If the patient shows signs of PCCS SCAI C while reducing ECCC, you can insert an Impella pump before ending ECC. That way, you will prevent upfront damage to the weakened heart through uloading.
Prevention of PCCS in High-Risk Cardiac Surgery Patients by Elective Insertion of pMCS
Dr. Veronika Walter, a colleague of Prof. Dr. Assad Haneya, delivers his presentation on innovative strategies for superior outcome in cardiac surgery at EACTS 2022. She reviews MCS devices suitable for postcardiotomy cardiogenic shock (PCCS), focusing on ECLS (or VA ECMO), microaxial pumps (Impella® heart pumps), and a combination of both.
- Velazquez, E. et al. (2026). N. Engl J Med, 374 (16), 1511-20.