IMPROVED RESULTS FOR POSTCARDIOTOMY CARDIOGENIC-SHOCK WITH THE USE OFIMPLANTABLE LEFT-VENTRICULAR ASSIST DEVICES

Background. Over the past decade, the use of mechanical circulatory su pport in patients with postcardiotomy cardiogenic shock has resulted i n hospital discharge rates of 25% to 40%. In an attempt to improve pat ient survival, we initiated a program of early insertion of an implant able Thermocardiosystems Incorporated Heartmate left ventricular assis t device in patients who have circulatory failure after having undergo ne high-risk cardiac operations. Methods. Between April 1993 and Febru ary 1997, 12 patients underwent insertion of an implantable left ventr icular assist device for postcardiotomy cardiogenic shock after corona ry artery bypass grafting. Indications for insertion included postoper ative cardiogenic shock (7 patients), postoperative cardiac arrest (3 patients), and failure to wean from cardiopulmonary bypass (2 patients ). Results. The median time to device insertion was 3.5 days. The mean duration of left ventricular assist device support was 103 +/- 19 day s (range, 2 to 225 days). Nine of 11 patients (82%) survived to underg o either transplantation (8 patients) or explantation (1 patient), wit h successful hospital discharge of all 9 patients. The major complicat ion was device-related infection (42%). A single thromboembolism occur red in a patient with an infection. Conclusions. Long-term outcome aft er postcardiotomy cardiogenic shock is improved substantially with the use of an implantable left ventricular assist device early in the pos toperative course. Access to such a device is an important considerati on before undertaking a high-risk cardiac operation, and early implant ation of the device is a critical factor in ensuring long-term surviva l. (C) 1997 by The Society of Thoracic Surgeons.