A SURVEY OF MECHANICAL MYOCARDIAL SUPPORT DEVICES 1997 - FROM INTRAAORTIC BALLOON COUNTERPULSATION TO IMPLANTABLE LEFT-VENTRICULAR ASSIST DEVICES

The development of cardiopulmonary bypass (CPB) to support the systemi c circulation during cardiac surgical procedures became a clinical rea lity in 1953. Although the use of CPB for the treatment of post-infarc tion cardiogenic shock met with little success, intra-aortic balloon c ounterpulsation was used successfully in 1968 to reduce ischaemic inju ry in a patient with cardiogenic shock. Today, a broad spectrum of cir culatory assist devi ces for short- and long-term application is avail able. Three major indication groups for the use of support devices are established. In low-cardiac-output syndrome after cardiac surgical pr ocedures,short-term devices are utilised to enable myocardial recovery . In transplantation candidates suffering from drug-resistant pump fai lure, the implantation of long-term devices as a bridge to heart trans plantation is indicated, and in NYHA class IV patients with contraindi cations to heart transplantation, the implantation of long-term device s as an alternative to transplantation is under discussion. In the lit erature, post-cardiotomy sup port survival is less than 30% on average . About 70% of mechanically bridged patients have survived to undergo heart transplantation and were transplanted with over 90% survival. Ma jor problems during mechanical support are infection, bleeding, and th rombembolism. In View of patients' natural course without support, the se clinical results are favourable.