Strategies for Temporary Mechanical Support: Contemporary Experience with Pulsatile and Non-pulsatile Support Systems

Authors

  • Nader Moazami
  • Marc R. Moon
  • Michael K. Pasque
  • Jennifer S. Lawton
  • Marci S. Bailey
  • Ralph J. Damiano, Jr.

DOI:

https://doi.org/10.1532/HSF98.20051130

Abstract

Despite advances in mechanical circulatory support, cardiogenic shock continues to have a high mortality. We reviewed our experience with pulsatile versus non-pulsatile temporary mechanical support at our institution to determine optimal strategy for survival.

From January 2001 to December 2003, mechanical support for cardiogenic shock was instituted in 38 patients.

Non-pulsatile devices (NP group) were used in 22 patients and pulsatile devices (P group) in 16 patients. Indications for the NP group were post-cardiotomy shock (PCS) in 17, myocardial infarction in 2, and isolated post-cardiotomy right ventricular failure in 3 patients. In the P group, 9 had the device placed for PCS, 3 for viral myocarditis, 1 after myocardial infarction, and 3 for right ventricular (RV) failure. Overall, bleeding, limb ischemia, and multi-system organ failure were higher in NP group with 5 weaned and 3 surviving to discharge (14%). In the P group, survivors included 7 weaned and 3 transplanted patients (63%).

With the exception of isolated RV failure, we obtained a dismal survival result with ECMO/centrifugal circuits for treatment of cardiogenic shock. For refractory pump failure, improved survival was achieved by using intermediate-term pulsatile devices with early transition to a chronic device and/or heart transplantation.

References

Smedira NG, Moazami N, Golding CM, et al. 2001. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years. J Thorac Cardiovasc Surg 122:92-102.nDembitsky W. 1999. Bridging from acute to chronic devices. Ann Tho-rac Surg 68:724-8.nDoll N, Kiaii B, Borger M, et al. 2004. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 77:151-7.nDeRose JJ, Slater JP, Spanier TB, et al. 1999. Improved survival rates support left ventricular assist device implantation early after myocardial infarction. J Am Col Card 33(7):1903-8.nDiGiorgi PL, Rao V, Naka Y, et al. 2003. Which patient, which pump? J Heart Lung Transplant 22:221-33.nECLS registry report. International Summary. July 2001. Extracorporeal Life Support Organization.nGolding LA, Crouch RD, Stewart RW, et al. 1992. Postcardiotomy centrifugal mechanical ventricular support. Ann Thorac Surg 54:1059-64.nHelman DN, Morales DLS, Edwards NM, et al. 1999. Left ventricular assist device bridge-to-transplant network improves survival after failed cardiotomy. Ann Thorac Surg 68(4):1187-94.nHoy FBY, Mueller DK, Geiss DM, et al. 2000. Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps? Ann Thorac Surg 70:1259-63.nKo WJ, Lin CY, Chen RJ, et al. 2002. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 73:538-45.nKörfer R, El-Banayosy A, Arusoglu L, et al. 1999. Temporary pulsatile ventricular assist devices and biventricular assist devices. Ann Thorac Surg 68:678-83.nMoazami N, Smedira NG. 2001. Temporary mechanical support. J Card Surg 16(3):193-202.nMoazami N, Moon MR, Lawton JS, et al. 2003. Axillary artery cannulation for extracorporeal membrane oxygenator support in adults: An approach to minimize complications. J Thorac Cardiovasc Surg 6(126): 2097-8.nMoazami N, Pasque MK, Moon MR, et al. 2004. Mechanical support for isolated right ventricular failure in post-cardiotomy patients. J Heart Lung Transplant 23(12):1371-5.nMorgan JA, Stewart AS, Lee BJ, et al. 2004. Role of the Abiomed BVS 5000 device for short-term support and bridge to transplantation. ASAIO Journal 50(4):360-3.nPae WE, Jr, Miller CA, Matthews Y, et al. 1992. Ventricular assist devices for post cardiotomy cardiogenic shock: a combined registry experience. J Thorac Cardiovasc Surg 104(3):541-3.nPagani FD, Aaronson KD, Dyke DB, et al. 2000. Assessment of an extracorporeal life support to LVAD bridge to heart transplant strategy. Ann Thorac Surg 70:1977-85.nPeek GJ, Firmin RK. 1999. The inflammatory and coagulative response to prolonged extracorporeal membrane oxygenation. ASAIO J 45(4):250-63.nPennington DG, Smedira NG, Samuels LE, et al. 2001. Mechanical circulatory support for acute heart failure. Ann Thorac Surg 71:S56-9.nSamuels LE, Holmes EC, Thomas MP, et al. 2001. Management of acute cardiac failure with mechanical assist: experience with the Abiomed BVS 5000. Ann Thorac Surg 71(3 Suppl):S67-72.nSmedira NG, Blackstone EH. 2001. Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg 71:S60-6.n

Published

2005-07-07

How to Cite

Moazami, N., Moon, M. R., Pasque, M. K., Lawton, J. S., Bailey, M. S., & Damiano, Jr., R. J. (2005). Strategies for Temporary Mechanical Support: Contemporary Experience with Pulsatile and Non-pulsatile Support Systems. The Heart Surgery Forum, 8(4), E216-E220. https://doi.org/10.1532/HSF98.20051130

Issue

Section

Articles

Most read articles by the same author(s)