Eleven years' experience with the Pierce-Donachy ventricular assist device.
During the last decade, mechanical circulatory support has been used in patients with cardiogenic shock refractory to conventional therapy. Since 1982, we supported 77 patients (78 implants) with Pierce-Donachy external pneumatic ventricular assist devices. Forty-two patients (35 after cardiotomy, four after heart transplantation, and three with acute infarction) 15 to 71 years of age (mean age 52 years) were supported for cardiac recovery. Left ventricular assist devices were used in 16 patients, right ventricular assist devices plus intraaortic balloon were used in nine, and biventricular assist devices were used in 17. Patients were supported 0.2 to 17 days (mean 4.4 days), 18 patients (43%) were weaned, and 11 (26%) survived. Complications included acute myocardial infarction (60%), bleeding (48%), infection (38%), and renal failure (24%). Bridging to transplantation was attempted in 35 patients (one patient underwent the procedure twice), 12 to 63 years of age (mean age 40 years). Left ventricular assist devices were used 19 times, and biventricular assist devices were used 17 times. Duration of support was 0.2 to 95 days (mean 24 days). All 20 patients who underwent transplantation were discharged. Of the 15 patients who did not undergo transplantation, two were weaned and survived, whereas the remaining 13 patients (who did not undergo transplantation because of complications) died with the device in place. In the patients in the bridge to transplantation group, bleeding occurred in 26%, infection in 55%, and renal failure in 15%. In the entire group of 77 patients, the incidence of ventricular assist device-related thromboembolism was 6%, but only 4% had neurologic deficits.(ABSTRACT TRUNCATED AT 250 WORDS)
Pennington
D G
DG
Department of Surgery, St. Louis University Health Sciences Center, MO 63110.
McBride
L R
LR
Miller
L W
LW
Swartz
M T
MT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002648:Child; D004867:Equipment Design; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D009460:Neurologic Examination; D051437:Renal Insufficiency / Q000209:etiology; D012770:Shock, Cardiogenic / Q000628:therapy; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right