Myocardial depression after cardiac surgery: pharmacologic and mechanical support

Cardiovascular surgery patients may experience a low cardiac output state as a result of anesthesia, cardiopulmonary bypass, and myocardial stunning. Prompt assessment and early intervention are critical to patient survival. A variety of pharmacologic agents are available to support the failing circulation, including several promising new experimental inotropic agents. Intraaortic balloon pumps (IABP) and ventricular assist devices (VAD) are additional therapies reserved for advanced cardiac decompensation that is unresponsive to pharmacologic treatment. A review of etiologic factors precipitating postcardiotomy failure is presented, and traditional and experimental inotropic agents are discussed. An overview of mechanical cardiac support with the IABP, centrifugal and pneumatic VAD, and the Hemopump (Johnson & Johnson Interventional Systems, New Brunswick, NJ) device is presented, all of which addresses information critical to optimal patient outcomes.