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      Complete mechanical circulatory support using ventricular assist devices for post-cardiotomy biventricular failure

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          Abstract

          Cardiopulmonary bypass (CPB) allows operations on the heart in a motionless and bloodless field while reducing cardiac workload and sustaining systemic and coronary perfusion. Failure to wean from CPB remains a significant problem. Results from recent large registry data have shown dramatic improvement in the survival following ventricular assistance for post cardiotomy failure if instituted early. We show how post-cardiotomy heart failure can be successfully treated by proactive use of biventricular assist devices (BIVAD).

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          Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation: third annual report--2005.

          , Marshall I. Hertz, Jane C. Deng … (2005)
          Article 0 comments Cited 26 times – based on 0 reviews     Review now
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            A decade of short-term outcomes in post cardiac surgery ventricular assist device implantation: data from the Society of Thoracic Surgeons' National Cardiac Database.

            Karen Peterson, Fabian Camacho, Bradley G. Hammill … (2007)
            Previous studies showed 75% mortality before hospital discharge in patients with a ventricular assist device (VAD) placed for post-cardiac surgery shock. We examined a large national clinical database to assess trends in the incidence of post-cardiac surgery shock requiring VAD implantation, survival rates, and risk factors for mortality. We identified patients undergoing a VAD procedure after cardiac surgery at US hospitals participating in the Society of Thoracic Surgeons' National Cardiac Database during the years 1995 to 2004. Baseline characteristics and operative outcomes were analyzed in 2.5-year increments. Logistic regression modeling was performed to provide risk-adjusted operative mortality and morbidity odds ratios. A total of 5735 patients had a VAD placed during the 10-year period (0.3% cardiac surgeries). Overall survival rate to discharge after VAD placement was 54.1%. With the earliest period (January 1995 through June 1997) used as reference, the mortality odds ratio declined to 0.72 (July 1997 through December 1999) and eventually to 0.41 (July 2002 through December 2004; P<0.0001). The combined mortality/morbidity odds ratio also declined, to 0.84 and 0.48 over identical periods (P<0.0001). Preoperative characteristics associated with increased mortality were urgency of procedure, reoperation, renal failure, myocardial infarction, aortic stenosis, female sex, race, peripheral vascular disease, New York Heart Association class IV, cardiogenic shock, left main coronary stenosis, and valve procedure (c index=0.755). After adjustment for clinical characteristics of patients requiring mechanical circulatory support, rates of survival to hospital discharge have improved dramatically. Insertion of a VAD for post-cardiac surgery shock is an important therapeutic intervention that can salvage most of these patients.
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              Acute and temporary ventricular support with BioMedicus centrifugal pump.

              George Noon, Javier A Lafuente, Suellen Irwin (1999)
              Short-term ventricular and pulmonary support can be provided by the Medtronic BioMedicus (Eden Prairie, MN) centrifugal pump, which is available in most cardiovascular surgery centers. This versatile pump can provide support during cardiopulmonary resuscitation, cardiopulmonary bypass, extracorporeal membrane oxygenation, and ventricular assistance. A common use of the pump is to provide ventricular assistance for patients after cardiotomy or cardiogenic shock. From January 1986 to September 1995, 141 patients at The Methodist Hospital in Houston, Texas were placed on the BioMedicus centrifugal pump after postcardiotomy cardiac failure. Patient treatment and postimplant complications are discussed. Fifty-four percent of the patients were weaned; however, only 22% survived to discharge. There was a very high mortality rate in the early stage after support was discontinued, after weaning, and after device removal. A high incidence of complications and death is likely related to the period of attempted weaning from cardiopulmonary bypass before the initiation of ventricular support. When weaning a patient from the pump during cardiopulmonary bypass or during ventricular assistance, it is important to optimize preload, after-load, ventricular function, and cardiac rhythm. In patients who have had postcardiotomy support, avoiding fluid overload, low colloid oncotic pressure, hypoperfusion, and use of excessive inotropic and vasoactive medications improve results.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ulster Med J
                Title: The Ulster Medical Journal
                Publisher: The Ulster Medical Society
                ISSN (Print): 0041-6193
                Publication date (Print): January 2008
                Volume: 77
                Issue: 1
                Pages: 36-38
                Affiliations
                [1 ]Department of Vascular and Endovascular Surgery, Barts and The London NHS Trust, The Royal London Hospital London E1 1BB, UK
                [2 ]Department of Cardiac Surgery, Royal Victoria Hospital Belfast, Northern Ireland, UK
                Author notes
                Correspondence to Mr Bonde, prambond@ 123456hotmail.com
                Article
                PMC ID: 2397010
                PubMed ID: 18269116
                SO-VID: cc7391dd-fed5-4c45-ac99-60b977160aad
                Copyright © © The Ulster Medical Society, 2008
                History
                Date accepted : 06 September 2007
                Categories
                Subject: Technical Note

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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