Bridge to recovery for postcardiotomy failure: Is there still a role for centrifugal pumps?

Background. Early implantation of centrifugal devices in patients with post cardiotomy cardiogenic shock may provide a bridge to recovery and allow sub sequent long-term survival. Methods. Since January 1989, 62 patients were supported with centrifugal pu mps because of failure to wean from cardiopulmonary bypass. Indications wer e postcardiotomy cardiogenic shock (PCCS) (n = 60), bridge to cardiac retra nsplantation (n = 1), and right ventricular failure (n = 1). Patients' ages ranged from 23 to 78 years; 40 were men (65%), and 22 were women (35%). Tw enty-two patients (35%) had a left ventricular assist device; 9 patients (1 5%) had a right ventricular assist device; and 31 patients (50%) had a bive ntricular assist device. Length of support ranged from 1 day to 19 days. Results. Forty-two patients (68%) were weaned successfully; 27 patients sur vived to discharge (44%). Complications included bleeding (n = 41, 66%), re nal failure (n = 28, 45%), and respiratory failure (n = 26, 42%). Currently , 23 patients survived 10 or more years (n = 1), 6 to 10 years (n = 7), 1 t o 5 years (n = 10), and less than 1 year (n = 5). Conclusions. Centrifugal pumps are available, easy to use, and relatively i nexpensive. Our experience justifies their continued use as a bridge to rec overy for patients with postcardiotomy cardiogenic shock, despite the avail ability and increasing use of more expensive devices. (C) 2000 by The Socie ty of Thoracic Surgeons.