Ventricular assist devices for postcardiotomy cardiogenic shock. A combined registry experience.
Data submitted voluntarily to the combined registry since its inception in 1985 to December 31, 1990, on the use of ventricular assist devices for postcardiotomy cardiogenic shock in 965 patients were analyzed. Approximately 45% of patients were weaned from temporary circulatory assistance and 24.6% reached hospital discharge regardless of the original operation. In 90% of patients who were discharged from the hospital, circulatory support was able to be discontinued by 1 week. Rates of weaning and discharge were statistically different and favored those patients requiring univentricular support only. Results were equal whether nonpulsatile centrifugal or pulsatile pneumatic devices were used for support. Although complications were frequent and multiple during assist pumping, patient variables including age greater than 70 years rather than direct complications caused by circulatory support were likely to affect overall outcome. In patients achieving hospital discharge, 2-year actuarial survival was 82% with 86% of patients being in New York Heart Association functional class I or II. In rare instances of device dependency in 43 patients (4.5%) with no contraindications to transplantation, 32 (74.4%) underwent bridge to cardiac transplant and 20 (62.5%) were discharged. This multi-institutional experience would continue to support the use of ventricular assist devices in postcardiotomy cardiogenic shock.
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Department of Surgery, College of Medicine, Pennsylvania State University, Hershey 17033.
Miller
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Matthews
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Pierce
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D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012042:Registries; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D013997:Time Factors