Mechanical circulatory assistance for postoperative cardiogenic shock: a three year experience.
Retrospective analysis of 14 patients undergoing circulatory support for postcardiotomy cardiogenic shock during the past 3 yrs has demonstrated the ability of the profoundly depressed myocardium to recover. Four patients were totally weaned from circulatory support and 2 are long-term survivors. Our results suggest that improved survival is dependent on the absence of certain peri-operative complications. To improve future clinical results we suggest that prompt application of assist pumping is necessary to eliminate prolonged cardiopulmonary bypass times and subsequent massive bleeding; those circulatory support systems requiring systemic anticoagulation are of no value in the treatment of postcardiotomy cardiogenic shock; the use of atrial cannulation may be advantageous in certain patients to eliminate critical inflow obstruction, further prolongation of cardiopulmonary bypass, and additional myocardial damage; and that the high incidence of right ventricular failure that is refractory to medical therapy makes the ability to support both ventricles mandatory.
D000328:Adult; D000368:Aged; D001243:Assisted Circulation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy*