Postcardiotomy low cardiac output clinical experience with a left heart assist device

Fifteen patients with advanced heart disease who could not be withdrawn from cardiopulmonary bypass (CPBP) because of low cardiac output were supported with a left heart assist device (LHAD). The system (left atrium to ascending aorta bypass of left ventricle) was not employed until all other measures had failed to allow separation from CPBP, including intraaortic balloon counterpulsation whenever possible. In this experience no attempt was made to totally bypass the left ventricle (LV). Rather, LHAD flow rate was adjusted so that the combined output of the LHAD and depressed LV achieved satisfactory levels of systemic blood flow at acceptable LV filling pressures. With improved cardiac performance patients were separated from the LHAD without need for thoracic reentry. Of the 15 patients having LHAD support (longest 21 days), 10 could be separated from the device and six were dismissed from the hospital. Four remain well, the longest 1.6 years postoperatively. Patients requiring 3 days or less of circulatory assistance had a more favorable prognosis than those needing more extended periods of support.