Effect of perioperative myocardial infarction on survival of postcardiotomy patients supported with ventricular-assist devices.
Ventricular-assist devices (VAD) have increased survival in patients with postcardiotomy shock, but the predictors of success need to be elucidated. We evaluated 45 patients treated with centrifugal (n = 18) or pulsatile (n = 27) VAD for postcardiotomy cardiogenic shock to determine the effect of perioperative myocardial infarction (PMI) on survival. The patients ranged in age from 15 to 72 years (mean age, 55.1 years). VAD support was left ventricular in 29, right ventricular in seven, and biventricular in nine, and the flow-rate range was 1.6-5.2 l/min (mean rate, 3.97 l/min) for 0.2-22 days (mean time, 4.1 days). PMI was determined by analysis of postoperative electrocardiogram (EKG), enzyme levels, or at necropsy. PMI was considered "possible" if there were either EKG or enzyme level changes, and "definite" if there were EKG and enzyme level changes or necropsy evidence. Of the 45 patients, 19 were successfully weaned from ventricular assistance; 12 were discharged (Group 1), and seven died (Group 2); the remaining 26 patients could not be weaned from VAD support (Group 3). In Group 1, one patient had a definite PMI, and three had a possible PMI. Among the 33 nonsurvivors (Groups 2 and 3), 24 patients had PMI by necropsy examination. Definite PMI was much more common in nonsurvivors (72.7%) than in survivors (8.3%) (p less than 0.05). However, Group 2 nonsurvivors were weaned despite PMI in 100% of cases. These data suggest that, although PMI is a strong negative determinant of survival in postcardiotomy patients, it cannot be considered a contraindication because it does not preclude myocardial recovery.
Pennington
D G
DG
Department of Surgery, St. Louis University Medical Center, MO 63104.
McBride
L R
LR
Kanter
K R
KR
Swartz
M T
MT
Lagunoff
D
D
Palmer
D
D
Martin
T
T
Miller
L W
LW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001243:Assisted Circulation / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006333:Heart Failure / Q000209:etiology; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000209:etiology* / Q000473:pathology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality