Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps?
BACKGROUND
Early implantation of centrifugal devices in patients with postcardiotomy cardiogenic shock may provide a bridge to recovery and allow subsequent long-term survival.


METHODS
Since January 1989, 62 patients were supported with centrifugal pumps because of failure to wean from cardiopulmonary bypass. Indications were postcardiotomy cardiogenic shock (PCCS) (n = 60), bridge to cardiac retransplantation (n = 1), and right ventricular failure (n = 1). Patients' ages ranged from 23 to 78 years; 40 were men (65%), and 22 were women (35%). Twenty-two patients (35%) had a left ventricular assist device; 9 patients (15%) had a right ventricular assist device; and 31 patients (50%) had a biventricular assist device. Length of support ranged from 1 day to 19 days.


RESULTS
Forty-two patients (68%) were weaned successfully; 27 patients survived to discharge (44%). Complications included bleeding (n = 41, 66%), renal failure (n = 28, 45%), and respiratory failure (n = 26, 42%). Currently, 23 patients survived 10 or more years (n = 1), 6 to 10 years (n = 7), 1 to 5 years (n = 10), and less than 1 year (n = 5).


CONCLUSIONS
Centrifugal pumps are available, easy to use, and relatively inexpensive. Our experience justifies their continued use as a bridge to recovery for patients with postcardiotomy cardiogenic shock, despite the availability and increasing use of more expensive devices.
Hoy
F B
FB
Division of Cardiovascular and Thoracic Surgery and the Downstate Heart Transplant Center at OSF St. Francis Medical Center, Peoria, Illinois, USA.
Mueller
D K
DK
Geiss
D M
DM
Munns
J R
JR
Bond
L M
LM
Linett
C E
CE
Gomez
R C
RC
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate