Methods of acute postcardiotomy left ventricular assistance

Objective. Despite many technological advances in cardiovascular surgery, s ome patients still experience postcardiotomy left ventricular (LV) failure that is refractory to both inotropic support and intra-aortic balloon pump (IABP) placement. The primary author (MJR) recently changed from inflow can nulation at the right superior pulmonary vein/left atrial junction to inflo w cannulation at the dome of the left atrium, The purpose of this study was to compare data collected during placement of a left ventricular assist de vice (LVAD) at the junction of the right superior pulmonary vein with posit ioning the device in the dome of the left atrium, Experimental design, sett ing, and participants: the medical records of all patients undergoing cardi ac surgery by one author (MJR) between 1994 and 1997 were retrospectively r eviewed, and 4 patients requiring LVAD placement for short term postcardiot omy support were identified. Each patient's chart was reviewed for duration of LVAD support, average LVAD blood flows, pulmonary capillary wedge press ures (PCWP), preoperative characteristics, postoperative complications, and final outcome for the patients. Results. Accessing the left atrium through the dome resulted in excellent b lood flow through the LVAD and allowed for good LV decompression. Hemostasi s remained the most common complication regardless of the technique employe d; however, the enhanced visibility provided by accessing the left atrium v ia the dome made repairs less technically difficult. Three patients (75%) w ere able to be weaned from the LVAD and were discharged from the hospital t o home. Two of these patients were cannulated via the left atrial dome maki ng removal of the LVAD easier, thus exposing the patients to less additiona l operative time. One patient could not be weaned from LVAD support seconda ry to development of right ventricular failure requiring RVAD insertion and subsequent development of multiple organ failure syndrome. Conclusions, Patients requiring LV assistance following cardiopulmonary byp ass surgery traditionally have high levels of morbidity and mortality. In s pite of the complications associated with the placement of an assist device , we remain encouraged by the excellent LV decompression and systemic flows we achieved following implantation of the LVAD through the dome of the lef t atrium. The superior ease of implantation and decannulation provided bett er operative care and postoperative management for our patients.