Long-term results of ventricular assist pumping in postcardiotomy cardiogenic shock

Short-term survival of patients who require ventricular assist pumping for postcardiotomy cardiogenic shock has been encouraging and has provided enough survivors to allow evaluation of long-term results. We observed nine survivors, 39 to 69 years of age (mean = 54.6) for 10 to 53 months (mean = 31) after their discharge from the hospital. In three patients, the angiographic ejection fraction was normal before the operation, whereas in six patients it was moderately to severely impaired. All nine patients were in New York Heart Association Functional Class IV before operation. After operation, eight of the nine patients were in Functional Class I or II. In the remaining patient, the ejection fraction fell markedly and the postoperative functional class remained unchanged. Two patients were employed full-time and one, part-time. Five patients were retired but active and had no cardiac disability, although two of the five did have residual partial noncardiac disability. The remaining patient, a housewife, continued to have compensated congestive heart failure but was relieved of angina. During the follow-up period, five of the nine patients died suddenly after 12, 18, 25, 30, and 38 months from causes that included pulmonary embolus and probable arrhythmias. Survivors who have had ventricular assist pumping for postcardiotomy cardiogenic shock have a good chance of resuming active lives. The risk of being a "cardiac cripple" is small, as is the risk of significant noncardiac disability.