Abstract
Post-cardiotomy cardiogenic shock (PCCS) is a critical condition characterized by persistent low cardiac output syndrome (LCOS) that manifests either as an inability to wean from cardiopulmonary bypass (CPB) or as severe cardiac dysfunction in the immediate post-operative period despite optimal medical therapy. With an incidence of 2-20%, PCCS is associated with high morbidity, mortality, and healthcare resource utilization. This review explores the pathophysiology of PCCS while emphasizing mechanisms such as direct myocardial damage, ischaemia-reperfusion injury, and systemic effects of extracorporeal circulation. It also discusses key diagnostic tools for PCCS including echocardiography, pulmonary artery catheters, vasoactive inotropic scores (VIS), and lactate clearance, which facilitate early recognition and management. Treatment pathways centred on temporary mechanical circulatory support (tMCS), tailored to clinical scenarios such as the inability to wean from CPB or refractory LCOS. The pivotal role of the multi-disciplinary Heart Team in decision-making, collaboration, and patient-centred care is highlighted. Finally, weaning protocols and considerations for long-term outcomes are discussed, underscoring the need for timely interventions and a personalized approach. Advances in PCCS management continue to evolve, aiming to improve survival and long-term outcomes for this high-risk population.