Treating PCCS With Impella Devices


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.

What Are the Risks Associated With PCCS/LCOS?

Hemodynamic Instability

PCCS can lead to significant hemodynamic instability, which can result in low blood pressure, decreased cardiac output, and decreased organ perfusion. This can lead to multi-organ failure and death if not promptly and effectively managed.

Impaired Cardiac Function

PCCS can result in impaired cardiac function, which can lead to reduced cardiac output and increased workload on the heart. This can increase the risk of heart failure, arrhythmias, and other cardiovascular complications.


Despite advances in treatment, PCCS remains a significant cause of morbidity and mortality, with reported mortality rates ranging from 20-50%.

“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.

Identifying certain risk factors that can contribute to LCOD may inform the decision on treatment options. Identifying certain risk factors that can contribute to LCOD may inform the decision on treatment options.

Identifying the early hazard of Surgery. Identifying the early hazard of Surgery.

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.


How To Achieve Better Patient Outcome in PCCS?

Prof. Dr. med. Gregor Warnecke discusses how to achieve better outcomes in patients with postcardiotomy cardiogenic shock (PCCS).


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.

PCCS/LCOS Whitepaper

Download the whitepaper now.


  1. Velazquez, E. et al. (2026). N. Engl J Med, 374 (16), 1511-20.


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