RESULTS OF CIRCULATORY SUPPORT FOR POSTOPERATIVE CARDIOGENIC-SHOCK

Over the last 5 years, 15 patients received ventricular assist devices (VADs) (Group 1) and 5 received percutaneous cardiopulmonary support (CPS) (Group 2) while in postoperative cardiogenic shock. Group 1 cons isted of 8 men and 7 women ranging in age from 22 to 73 years (average age, 55 years). Nine of these patients underwent surgery for valve re placement, 5 for coronary artery bypass grafting, and 1 for closure of a ventricular septal rupture. The duration of VAD support ranged from 6 h to 9 days (mean, 3.9 days). Group 2 consisted of 4 men and 1 woma n ranging in age from 49 to 68 years (average age, 57 years). One of t hese patients underwent surgery for valve replacement, 1 for coronary artery bypass grafting, 2 for replacement of a thoracic aneurysm, and 1 for left ventricular aneurysmectomy. The duration of CPS ranged from 4 h to 8 days (mean, 2.8 days). In Group 1, 13 patients were weaned f rom the VADs and 8 survived. Bleeding occurred in 5 patients, renal fa ilure in 4, infection in 3, cardiac failure in 4, cerebral infarction in 1, perioperative myocardial infarction in 1, arrhythmia in 1, and i leus in 1. In Group 2, 4 patients were weaned from the CPS and 3 survi ved. Bleeding occurred in 3 patients, renal failure in 2, CNS injury i n 2, and cardiopulmonary failure in 1. The 8 survivors in Group 1 have been followed for 2 to 56 months (mean, 28.7 months). Five patients w ere in NYHA class I, 2 were in class II, and 1 was in class III, The 3 survivors in Group 2 have been followed for 6 to 18 months (mean, 10. 6 months). Two of these patients were in NYHA class I, and 1 was in cl ass III. The VADs and CPS were both effective in preventing circulator y failure, but serious complications were observed more frequently in patients with CPS.