A Simple Left Heart Assist Device For Use After Intracardiac Surgery: Development, Deployment and Clinical Experience

Abstract

A simple left heart assist device (LHAD) has been developed and employed in nineteen patients with severe left ventricular dysfunction who could not be weaned from cardiopulmonary bypass following intracardiac surgery. It has been used when all other means of weaning, including maximum pharmacologic therapy and intra-aortic balloon counterpulsation (IABC), had failed. The device utilizes specially designed and constructed obturated cannulae in the left atrium and the ascending aorta, and an extracorporeal roller pump to partially bypass the left ventricle. With improved cardiac performance, the patient may be separated from the device without need for thoracic reentry. Of the nineteen patients having LHAD support (2-500 hours), thirteen were eventually weaned from the device and seven were discharged from the hospital. Five patients remain alive and well (18 to 50 months postoperatively).

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

“…Another important factor leading to improved results has been the use of atrial rather than ventricular cannulation in all patients in this series. Our experience parallels that of others [2,3,6,9] suggesting that atrial cannulation is simpler, less injurious, and more effective than left ventricular cannulation. Left ventricular apex cannulation damages an already impaired left ventricle, requires multiple sutures for fixation, and tethers the heart in a position that does not allow exposure of the posterior surface in order to control bleeding.…”

“…Since the successful use of left heart bypass in postcardiotomy patients with cardiogenic shock by Spencer and associates in 1964 [1] and Debakey in 1966 [2], continued progress has been made with the clinical application of circulatory assist devices [3][4][5][6][7][8][9]. 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.…”

Right heart interaction with the mechanically assisted left heart

“…Right ventricular (RV) failure has been reported to be a major complication associated with the clinical use of LVADs. A review of the literature on clinical LVAD experience [1][2][3][4][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] along With our own results reveals that of 213 patients who received LVADs at 12 centers (not including patients with RVAD and IABP), 20 required the additional use of an RVAD for RV dysfunction and 29 died as a direct result of RV failure (Table 1). Thus, 49 patients (23%) treated with an LVAD for LV failure were candidates for biventricular support.…”

“…In contrast, Rose et al [28] have used a roller pump and IABP for LV assist in 35 patients and state that in no cases did RV dysfunction fail to respond to pharmacologic agents. Litwak et al [31] and Koffsky et al [14] reported supporting 19 patients in acute LV failure using a roller pump and IABP and make no mention of RV failure as an important problem. Holub et al [21] and Norman et al [25] after 22 cases have discussed RV failure as a potential limiting factor in LVAD support but have never done biventricular support.…”