title: Importance of luxury flow for critically ill patients receiving a left ventricular assist system.
abstract: The presence of a significant organ dysfunction does not immediately exclude patients from consideration for treatment with a left ventricular assist system (LVAS). However, in treating morbid circulatory shock patients with multiple organ failure, it is important to know the preoperative and postoperative factor or factors related to the recovery of the damaged organ function. In this study, we retrospectively analyzed patients receiving a LVAS at our institution and tried to determine the important factors related to the survival of patients with multisystem failure. Twenty-seven patients who underwent LVAS placement at Saitama Medical School Hospital between 1993 and 2003 were included in this study. The preoperative risk factors analyzed were renal dysfunction, respiratory dysfunction, hepatic dysfunction, the existence of active infection, and the combination of all four factors. As a postoperative factor, the pump flow index (mean LVAS pump flow during the first 2 weeks after LVAS surgery divided by the body surface area) was analyzed. None of the analyzed preoperative factors could predict survival after LVAS surgery, but a pump flow index of less than 2.5 l/min/m2 had a significant relationship with death after LVAS surgery. Further analysis revealed that all the patients with a pump flow index of 3.0 l/min/m2 or more could overcome preoperative organ dysfunction. Congestive heart failure patients with multisystem failure need luxury pump flow for successful LVAS surgery; this factor could be especially important in device selection and postoperative management.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical School, Saitama, Japan. nishimur@grape.med.tottori-u.ac.jp
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nishimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Ayumu
authors.initials: A
authors.lastname: Masuoka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Okamura
authors.forename: Keiko
authors.initials: K
authors.lastname: Abe
authors.forename: Takahiro
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Mika
authors.initials: M
authors.lastname: Iwazaki
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Imanaka
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Asano
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
mesh_terms: D002302:Cardiac Output; D016638:Critical Illness; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D009102:Multiple Organ Failure / Q000150:complications*; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis