Long-term follow-up of survivors of postcardiotomy circulatory support

Although it is now possible to obtain, with mechanical circulatory support devices, survival of postcardiotomy patients who develop profound cardiogenic shock, their long-term functional status has not been firmly established. We studied 22 patients who survived cardiac operations by the use of circulatory support devices. Their ages ranged from 3 days to 69 years at the time of device support. Operations performed were coronary artery bypass (9 pts), valve replacement (4 pts), congenital defect correction (8 pts), and cardiac transplantation (1 pt). Ten patients were supported with a Pierce-Donachy ventricular assist device (VAD) (left 4, right 3, both 3), nine with extracorporeal membrane oxygenation (ECMO), and three with centrifugal pumps (left 2, both 1). Duration of support ranged from 22 to 189 hours (mean 84.4). There were four late deaths; two of the deaths were cardiac-related within 6 months and two were due to cancer at 46 and 53 months following discharge. The remaining 18 survivors were followed for 6 to 74 months (mean 29.9). Prior to operation three of the patients were New York Heart Association (NYHA) Class I, eight were Class II, six patients were Class III, and five were Class IV. Following discharge from the hospital 13 patients were Class I, two were Class II, and three were Class III; no patients were Class IV. Five patients work full-time, three are retired without limitation, four attend school, and three are pre-school. Only three patients suffer from moderate cardiac disability. These data suggest that patients surviving mechanical circulatory assistance for postoperative cardiogenic shock have an excellent chance for functional recovery.