Postcardiotomy assisted circulation with roller pump--early and late results

Area of Science:

• Cardiology
• Cardiac Surgery
• Biomedical Engineering

Background:

• Postcardiotomy myocardial failure (PMF) occurs in 0.2% to 1.2% of cardiac surgery patients.
• Mechanical circulatory support beyond Intra-Aortic Balloon Pump (IABP) is crucial for severe PMF.
• Left Ventricular Assist Devices (LVADs) offer a potential solution for these critically ill patients.

Purpose of the Study:

• To evaluate the efficacy and outcomes of using a roller pump-driven LVAD for short-term circulatory support in patients with PMF.
• To assess the survival rates and functional status of patients treated with this LVAD configuration.

Main Methods:

• A retrospective analysis of 18 patients who received a roller pump LVAD for PMF between December 1989 and December 1995.
• Assisted flow rates ranged from 3.5 to 5 L/min, with an average support duration of 35.5 hours.
• Patient outcomes including in-hospital mortality, causes of death, hospital discharge, and long-term survival were analyzed.

Main Results:

• Six patients (33.3%) died while on LVAD support.
• Among patients weaned from LVAD, seven additional deaths occurred due to myocardial failure (4), stroke (2), and bleeding (1).
• Five patients (27.8%) were successfully discharged, with a 7-year actuarial survival rate of 60% in this group, all in NYHA functional class II.

Conclusions:

• Roller pump-driven LVADs are effective for short-term circulatory support in patients with postcardiotomy myocardial failure.
• Outcomes are comparable to existing data for similar devices, suggesting a viable treatment option.
• Long-term survivors demonstrated sustained functional capacity, highlighting the potential benefit of LVAD support in select PMF patients.