Current strategy of temporary circulatory support for severe cardiac failure after operation

Background. After open heart operations about 1% of patients still need tem porary circulatory support for severe cardiac failure, and over half of tho se patients die during or after the support. This study assessed the effica cy of the current strategy of circulatory support. Methods. We assessed clinical outcome of 64 consecutive patients (1.5% of p ump cases) who had temporary circulatory support associated with perioperat ive variables. The results were analyzed by logistic regression analysis. Results. The weaning and discharge rates were 50.0% and 26.7% with venoarte rial bypass, 76.2% and 57.1% with biventricular bypass, 87.5% and 37.5% wit h isolated left ventricular bypass, and 60.0% and 40.0% with pulsatile left ventricular assistance, respectively. Logistic regression analysis identif ied presupport cardiogenic shock (odds ratio, 9.922) and support type (14.6 84) as factors significantly associated with nonweaning from the temporary support, and cardiogenic shock (28.268), support duration (2.948), and supp ort type (14.184) as factors significantly associated with mortality during or after the circulatory support. Conclusions, The current strategy of temporary circulatory support improved clinical outcome of patients with severe cardiac failure. Early applicatio n of circulatory support before profound cardiogenic shock and proper selec tion of the support type might be key factors for successful circulatory su pport postoperatively after operation. (C) 1999 by The Society of Thoracic Surgeons.