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Long-term survival with partial left heart bypass following perioperative myocardial infarction and shock
Insights
Early use of partial left heart bypass (left atrium to ascending aorta) improved survival in critically ill patients. This intervention offered significant ventricular function improvement, leading to satisfactory long-term outcomes for survivors.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
- Critical Care Medicine
Background:
- Patients failing to wean from cardiopulmonary bypass often require advanced support.
- Inotropic agents and intra-aortic balloon pumps may be insufficient for severe cases.
Purpose of the Study:
- To evaluate the efficacy of partial left heart bypass (PLHB) in patients unable to be weaned from cardiopulmonary bypass.
- To assess the impact of PLHB on ventricular function and long-term survival.
Main Methods:
- A partial left heart bypass (left atrium to ascending aorta) was used in 16 patients.
- The device provided flow rates up to 3,500 ml/min.
- Bypass support duration ranged from 16 to 68 hours.
Main Results:
- Eight out of 16 patients survived and were discharged.
- Survivors showed significant improvement in ventricular function within 12-24 hours.
- Seven of the eight deaths were due to progressive myocardial failure.
Conclusions:
- Early institution of PLHB can be a life-saving intervention for critically ill cardiac patients.
- PLHB can lead to satisfactory long-term results in carefully selected patients.
- Significant improvement in ventricular function post-PLHB supports its clinical utility.
Abstract:
During the period from July 1, 1978 to Dec. 31, 1980, we employed a partial left heart bypass (left atrium to ascending aorta) in 16 patients who could not be weaned from cardiopulmonary bypass with inotropic agents and the intra-aortic balloon pump. Flow rates up to 3,500 ml/min could be obtained with this device. Eight of the 16 patients survived and left the hospital. One patient died of a cardiac arrest 4 months postoperatively and one has recurrent angina and moderate congestive heart failure 24 months postoperatively. Six patients are well 5 to 17 months after discharge. Seven of the eight deaths were characterized by progressive myocardial failure. One patient died of ventricular fibrillation 18 hours after discontinuation of the left heart bypass. All survivors had significant improvement in ventricular function 12 to 24 hours afer institution of the left heart bypass, which was continued for 16 to 68 hours. These results indicate that early institution of left heart bypass in seriously ill patients can provide satisfactory long-term results.