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Seven years' experience with the Pierce-Donachy ventricular assist device
D G Pennington1, K R Kanter, L R McBride
1Department of Surgery, St. Louis University Hospital, Mo.
The Journal of Thoracic and Cardiovascular Surgery
|December 1, 1988
Summary
The Pierce-Donachy ventricular assist device effectively supports patients with cardiogenic shock, showing improved outcomes and survival rates, particularly in post-operative and bridge-to-transplantation cases. However, complications like bleeding and infection remain significant challenges.
Area of Science:
- Cardiology
- Medical Engineering
- Thoracic Surgery
Background:
- Mechanical circulatory support is crucial for patients with severe cardiogenic shock.
- The Pierce-Donachy ventricular assist device (VAD) is a widely used external pneumatic device.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of the Pierce-Donachy VAD in diverse patient groups with refractory cardiogenic shock.
- To identify factors influencing survival and complications associated with VAD support.
Main Methods:
- Retrospective analysis of 48 patients (aged 15-71) receiving Pierce-Donachy VAD support between 1981 and an unspecified date.
- Patients were categorized into four groups: post-cardiac surgery, bridge-to-transplantation, post-transplant support, and acute myocardial infarction.
- Data collected included duration of support, survival rates, weaning success, discharge rates, and complications.
Main Results:
- In the largest group (30 patients) of post-cardiac surgery patients, 53% showed improved cardiac function, 50% were weaned, and 36% were discharged. Survival improved from 27% in the initial cohort to 47% in the later cohort.
- For 11 patients as a bridge to transplantation, 5 achieved successful transplantation, with one late death. One patient remains on support after 84 days.
- Four patients with refractory cardiogenic shock post-transplantation all died within 6 days due to infection and/or renal failure.
Conclusions:
- The Pierce-Donachy VAD demonstrates versatility and effectiveness in supporting patients with refractory cardiogenic shock, offering a survival benefit.
- Key challenges include managing complications such as bleeding (52%) and infection (27%), and addressing comorbidities like myocardial infarction and renal failure.
- While VAD support can facilitate transplantation, outcomes in post-transplant scenarios remain poor, necessitating further research and improved management strategies.