Left ventricular assist without thoracotomy: clinical experience with the Dennis method.
A method to provide left ventricular circulatory assistance without thoracotomy was developed and implemented in 2 patients. The left atrium is cannulated from the neck by passing a catheter across the interatrial septum (Dennis technique) using fluoroscopic and echocardiographic imaging. To facilitate ambulation, the arterial catheter is connected to the right axillary artery. Left atrial to axillary arterial flow is produced by a centrifugal pump. Two patients were perfused at 2.7 to 3.5 L/min for 5 and 6.5 days. One patient had successful coronary angioplasty during perfusion and remains alive 1 year later. The other patient died of sepsis and anuria that preceded implementation of circulatory assistance. The Dennis method of continuous left ventricular circulatory assistance avoids thoracotomy, requires a minimal operation, is portable and inexpensive, uses widely available equipment, and is particularly suitable for patients in cardiogenic shock after acute myocardial infarction. The method is safe and cost-effective, and merits wider application in selected patients.
Edmunds
L H
LH
Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia.
Herrmann
H C
HC
DiSesa
V J
VJ
Ratcliffe
M B
MB
Bavaria
J E
JE
McCarthy
D M
DM
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D015505:Chest Tubes; D004434:Early Ambulation; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D017809:Fatal Outcome; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013908:Thoracotomy; D013997:Time Factors