EXPERIENCES OF POSTCARDIOTOMY ASSIST - PNEUMATIC VENTRICULAR ASSIST DEVICE OR VENOARTERIAL BYPASS WITH PERCUTANEOUS CARDIOPULMONARY SUPPORT

From October 1982 to the present, 16 patients have been supported by a pneumatic ventricular assist device (VAD). Since April 1990, we have introduced a venoarterial bypass (VAB) with percutaneous cardiopulmona ry support (PCPS) system. This PCPS system was used in 12 patients. Th e long-term survival rate of PCPS cases (41%) was much better than tha t of VAD cases (19%). The main cause of death in VAD cases was multipl e organ failure (MOF). Although VAB was initiated more recently than V AD, the duration on support was longer in the VAD group than in the VA B group. Because of the longer support duration and the presence of ma ny patients with MOF, coagulopathy deteriorated more readily in the VA D group than in the VAB group. In the case of postcardiotomy cardiopul monary bypass weaning or low-output syndrome (LOS), the VAB with PCPS system should be applied first under intraaortic balloon pumping assis t because of its simplicity and low cost. Thereafter, VAD should be ap plied in cases refractory to VAB support.