European Heart Journal Supplements: Key Insights into Post-Cardiotomy Cardiogenic Shock by Dr. Ahmad Mahajna

Key Takeaways: 

• PCCS Scenarios: Post-cardiotomy cardiogenic shock (PCCS) requires swift assessment, particularly in scenarios involving challenges in weaning from cardiopulmonary bypass (CPB) or persistent low cardiac output syndrome (LCOS).
• Early Recognition and Monitoring: Early identification utilizes echocardiography, pulmonary artery catheterization, and lactate measurements to monitor patient status effectively.
• Escalation to Mechanical Support: Prompt escalation to temporary mechanical circulatory support (MCS) devices, such as Impella® heart pump, can significantly enhance patient outcomes.
   

Ahmad Mahajna, MD, discusses highlights from his paper “Current insights on temporary mechanical circulatory support in adults with post-cardiotomy cardiogenic shock,” published in the 2025 European Heart Journal supplement titled “Mechanical Circulatory Support in Special Settings: the Heart Team Approach.” Dr. Mahajna is a cardiothoracic surgeon at Rambam Medical Center in Haifa, Israel.

Dr. Mahajna explains that this publication reflects the collaborative effort to provide clarity on managing post-cardiotomy cardiogenic shock [PCCS], a challenging condition with evolving treatment pathways, especially regarding the use of temporary mechanical circulatory support [MCS].

Dr. Mahajna identifies two classic scenarios for PCCS, both of which require rapid assessment: inability to wean from cardiopulmonary bypass (CPB) and refractory low cardiac output syndrome (LCOS) after surgery. “We focussed on early recognition,” he explains. “It’s important to have echocardiography, pulmonary artery catheter (Swan-Ganz), and lactate measurement to define and monitor conditions and status.” He adds, “If myocardial recovery is uncertain, we escalate to temporary mechanical support, like Impella CP® heart pump and Impella 5.5 heart pump, or VA ECMO, depending on the ventricular needs... Early and pre-emptive mechanical support can improve outcomes.”

“The heart team is pivotal,” he states, explaining that this team includes cardiac surgeons, intensivists, heart failure specialists, and anesthesiologists, who are involved in pre-operative and intra-operative decision making. The team ensures timely initiation of MCS and individualized patient care.

Dr. Mahajna’s concluding thoughts highlight early recognition of post-cardiotomy cardiogenic shock. “Act fast. Tailor support to the patient’s need. Use structured tools like VIS score [vasoactive inotropic score], pulmonary artery catheter, and lactate to guide escalation. And always engage the heart team. Timely, personalized, temporary mechanical support saves lives.”