Mechanical circulatory assistance for postoperative cardiogenic shock: a three year experience

Retrospective analysis of 14 patients undergoing circulatory support for postcardiotomy cardiogenic shock during the past 3 yrs has demonstrated the ability of the profoundly depressed myocardium to recover. Four patients were totally weaned from circulatory support and 2 are long-term survivors. Our results suggest that improved survival is dependent on the absence of certain peri-operative complications. To improve future clinical results we suggest that prompt application of assist pumping is necessary to eliminate prolonged cardiopulmonary bypass times and subsequent massive bleeding; those circulatory support systems requiring systemic anticoagulation are of no value in the treatment of postcardiotomy cardiogenic shock; the use of atrial cannulation may be advantageous in certain patients to eliminate critical inflow obstruction, further prolongation of cardiopulmonary bypass, and additional myocardial damage; and that the high incidence of right ventricular failure that is refractory to medical therapy makes the ability to support both ventricles mandatory.