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Acute and temporary ventricular support with BioMedicus centrifugal pump
G P Noon1, J A Lafuente, S Irwin
1Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA.
The Annals of Thoracic Surgery
|September 4, 1999
Summary
The Medtronic BioMedicus centrifugal pump offers short-term cardiac support, but weaning from this ventricular assistance device after postcardiotomy cardiac failure is associated with high mortality rates. Careful management of patient hemodynamics and medications is crucial for improving outcomes.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
Background:
- The Medtronic BioMedicus centrifugal pump provides versatile short-term ventricular and pulmonary support.
- It is commonly used for ventricular assistance in patients experiencing postcardiotomy cardiac failure or cardiogenic shock.
Purpose of the Study:
- To evaluate the outcomes of patients requiring ventricular assistance with the BioMedicus centrifugal pump after postcardiotomy cardiac failure.
- To identify factors contributing to complications and mortality in this patient population.
Main Methods:
- A retrospective review of 141 patients who received BioMedicus centrifugal pump support for postcardiotomy cardiac failure from January 1986 to September 1995.
- Analysis of patient treatment, weaning protocols, and postimplant complications.
Main Results:
- 54% of patients were successfully weaned from the pump.
- However, only 22% survived to hospital discharge.
- A significant early mortality rate was observed after support discontinuation, weaning, and device removal.
Conclusions:
- High complication and mortality rates may be linked to the timing of weaning attempts prior to initiating ventricular support.
- Optimizing preload, afterload, ventricular function, and cardiac rhythm is critical during weaning.
- Avoiding fluid overload, maintaining adequate colloid oncotic pressure, preventing hypoperfusion, and judicious use of medications can improve outcomes in postcardiotomy patients.