CENTRIFUGAL VENTRICULAR ASSIST DEVICE FOR SUPPORT OF THE FAILING HEART AFTER CARDIAC-SURGERY

Objective: To determine the morbidity and mortality associated with us e of centrifugal ventricular assist devices for postcardiotomy cardiog enic shock and to determine factors that might influence outcome and t hus, aid in patient selection. Design: A retrospective study. Setting. Surgical intensive care unit in a university hospital. Patients: Duri ng a 6-yr period, a total of 7,385 adult patients underwent cardiac op erations requiring cardiopulmonary bypass. Myocardial protection consi sted of single-dose cold crystalloid cardioplegia and continuous topic al hypothermia by saline lavage. A total of 72 (1%) patients developed postcardiotomy cardiogenic shock. Of 72 patients, 28 met the institut ional criteria and were placed on centrifugal ventricular assist devic es. Interventions: Twenty-eight adult patients with postcardiotomy car diogenic shock were supported with centrifugal ventricular assist devi ces. Measurements and Main Results: A total of 15 patients received le ft ventricular assist devices, five received right ventricular assist devices, and eight received both right and left ventricular assist dev ices. Mean age of ventricular assistance patients was 50.8 +/- 12.9 yr s (range 22 to 72), and mean duration of ventricular assistance was 2. 8 +/- 2.5 days (range 4 hrs to 10 days; median 2 days). Twenty-five co mplications occurred in 16 patients and included bleeding (13), tampon ade (2), systemic embolism (6), seizures (2), and sepsis (2). Nine pat ients required reexploration for bleeding or tamponade. Nine (32%) of 28 patients were discharged from the hospital. Ventricular assistance for cardiac failure after transplantation was associated with improved survival (p <. 10), while age >50 yrs and postoperative tamponade eac h showed trends toward association with mortality (p = .10). Survival was not predicted by gender, weight, time on cardiopulmonary bypass, a ortic cross-clamp time, urgency of operation, or preoperative congesti ve heart failure. At 27 +/- 20 months follow-up, all survivors were al ive and New York Heart Association functional class I or II. Conclusio ns: These results document a low incidence of ventricular assist devic e use in a surgical practice that employs a relatively simple method o f myocardial protection. When postcardiotomy ventricular assistance wa s necessary, a centrifugal pump was used and successful outcome and sa tisfactory long-term results were possible in nearly one third of pati ents. Ventricular assistance for cardiac failure after transplantation was associated with improved survival. Older age is a relative contra indication to mechanical ventricular assistance.