A Servocontrolled Atrial-Aortic Assist Device: Experimental Findings and Clinical Experience

Laks, Hillel; Marco, Joseph D.; Farmer, Thomas L.; Standeven, John; Kaiser, George C.; Willman, Vallee L.

doi:10.1016/s0003-4975(10)64473-6

Cited by 10 publications

(1 citation statement)

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“…Although the role of ventricular assist devices (VAD) has been expanded to include patients with ventricular failure due to myocardial infarction shock [6,10] and patients awaiting cardiac transplantation [11,12], postoperative cardiogenic shock remains the predominant indication for their use. At St. Louis University, several different ventricular assist systems have been employed over the last 8 years including a roller pump [13], a centrifugal pump [7], an extracorporeal membrane oxygenator [14], and the Pierce-Donachy pulsatile sac-type pump [15]. This review describes our most recent experience with the Pierce-Donachy pump in patients with postcardiotomy ventricular failure.…”

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Experience with the pierce‐Donachy ventricular assist device in postcardiotomy patients with cardiogenic shock

et al. 1985

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In order to assess the current status of ventricular assist device (VAD) support of patients with postcardiotomy ventricular failure, we evaluated the data from 17 patients treated over a 2‐year period with a Pierce‐Donachy paracorporeal pneumatic sac‐type VAD using atrial cannulation and asynchronous pumping. All patients had severe ventricular failure refractory to intra‐aortic balloon (IAB) and drug therapy. The effects of the VAD on left ventricular function were evaluated by nuclear ventriculography and hemodynamic measurements during brief pump on/pump off periods. Eight patients received only left VAD's, 5 received right VAD's and IAB, and 4 received 2 VAD's. All patients were weaned from cardiopulmonary bypass with VAD flows ranging from 1.55 to 2.78 L/min per m2.Eight patients died of bleeding, biventricular failure, or multiple organ failure without improvement in cardiac function. However, 9 patients (53%) had improved cardiac function, 8 were weaned from the VAD, and 7 (41%) were discharged. Five of the last 6 patients survived. Two patients with isolated left ventricular failure survived with left VAD alone. However, of 15 patients with biventricular failure, 5 of 9 receiving biventricular assistance were weaned, while only 1 of 6 receiving left VAD alone was weaned. Although activation of the left VAD decreased left ventricular ejection fraction, left atrial pressure, and left ventricular volume, it concomitantly increased left ventricular afterload. The Pierce‐Donachy VAD provided salvage of patients with severe ventricular failure after cardiac operations. The majority of patients had biventricular failure, which was best treated with biventricular mechanical support. Although the VAD reduced left ventricular preload, ejection fraction decreased as afterload increased, suggesting that asynchronous left atrial pumping does not unload the left ventricle.

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