Strategies for temporary mechanical support: contemporary experience with pulsatile and non-pulsatile support systems.
Despite advances in mechanical circulatory support, cardiogenic shock continues to have a high mortality. We reviewed our experience with pulsatile versus non-pulsatile temporary mechanical support at our institution to determine optimal strategy for survival. From January 2001 to December 2003, mechanical support for cardiogenic shock was instituted in 38 patients. Non-pulsatile devices (NP group) were used in 22 patients and pulsatile devices (P group) in 16 patients. Indications for the NP group were post-cardiotomy shock (PCS) in 17, myocardial infarction in 2, and isolated post-cardiotomy right ventricular failure in 3 patients. In the P group, 9 had the device placed for PCS, 3 for viral myocarditis, 1 after myocardial infarction, and 3 for right ventricular (RV) failure. Overall, bleeding, limb ischemia, and multi-system organ failure were higher in NP group with 5 weaned and 3 surviving to discharge (14%). In the P group, survivors included 7 weaned and 3 transplanted patients (63%). With the exception of isolated RV failure, we obtained a dismal survival result with ECMO/centrifugal circuits for treatment of cardiogenic shock. For refractory pump failure, improved survival was achieved by using intermediate-term pulsatile devices with early transition to a chronic device and/or heart transplantation.
Moazami
Nader
N
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. moazamin@wustl.edu
Moon
Marc R
MR
Pasque
Michael K
MK
Lawton
Jennifer S
JS
Bailey
Marci S
MS
Damiano
Ralph J
RJ
D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy*