Current strategy of temporary circulatory support for severe cardiac failure after operation

Kitamura, Masaya; Aomi, Shigeyuki; Hachida, M; Nishida, Hiroshi; Endo, Masahiro; Koyanagi, Hitoshi

doi:10.1016/s0003-4975(99)00525-1

Cited by 22 publications

(14 citation statements)

References 8 publications

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“…RV failure has a multifactorial etiology with prolonged extracorporeal circulation, RV ischemia, arrhythmogenic RV cardiomyopathy, pulmonary hypertension, transfusion of numerous blood products, and use of vasopressors being the most frequent causes (2,12). Although rare, RV failure accounts for over 40% of operating room deaths after cardiac transplantation (3), and for a mortality greater than 50% after circulatory support with an extracorporeal membrane oxygenation (ECMO) for postcardiotomy failure (5). Results after RV support in LVAD recipients are similar (12).…”

Section: Discussionmentioning

confidence: 99%

“…Results after RV support in LVAD recipients are similar (12). The type of cardiac support is one of the most important figures influencing mortality and nonweaning from temporary circulatory support (5). Due to the poor results with ECMO and paracorporeal RV assist devices (3,5,11,12), the development of new RV support devices appears to be necessary.…”

Section: Discussionmentioning

confidence: 99%

“…The type of cardiac support is one of the most important figures influencing mortality and nonweaning from temporary circulatory support (5). Due to the poor results with ECMO and paracorporeal RV assist devices (3,5,11,12), the development of new RV support devices appears to be necessary. This becomes more and more true regarding the considerable number of complications with currently used RV support devices (10).…”

Section: Discussionmentioning

confidence: 99%

“…This is true for postcardiotomy failure, biventricular failure, as well as RV failure after left ventricular (LV) assist device (LVAD) implantation or cardiac transplantation (1–4). Only 15–35% of these patients survive and are discharged from hospitals (1,2,4–6).…”

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confidence: 99%

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In Vivo Experimental Testing of a Microaxial Blood Pump for Right Ventricular Support

Christiansen

Pérez-Bouza²,

Reul³

et al. 2006

Artificial Organs

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The incidence of isolated right ventricular (RV) failure is rare in postcardiotomy patients, but high in patients undergoing implantation of a left ventricular assist device or cardiac transplantation. Therefore, we have developed a new microaxial flow device and report on our first in vivo animal trials. Six healthy adult female sheep weighing 80-90 kg underwent implantation of the microaxial blood pump for partial unloading of the right ventricle. This pump is a miniaturized rotary blood pump with a diameter of only 6.4 mm and a weight of 11 g. The inner volume of the pump is limited to 12 mL, and the inner artificial blood contacting surface is 65 cm(2). The pump consists of a rotor driven by an incorporated brushless direct current motor, the housing of the rotor, the inflow cage, the outflow cannula, and the driveline. At the maximum speed of 32,500 rotations/min, a flow of 6 L/min can be delivered. The inflow and outflow conduit were anastomosed to the right atrium and the main pulmonary artery, respectively. Hemodynamic and echocardiographic data as well as blood samples were measured over the whole test period of 7 days. The hearts and lungs as well as the pump were explanted for a thorough examination at the end of the trial. Systemic arterial blood pressures remained unchanged during the entire test period. RV cardiac output was diminished significantly as demonstrated by the echocardiographic studies. The number of platelets decreased perioperatively, but recovered within the test period. The free hemoglobin was not enhanced postoperatively indicating no significant hemolysis. Liver function was only slightly impaired due to operative reasons (increase in bilirubin on the first postoperative day but normalization within the test period). The pathologic examination revealed some clots at the inflow cage and fibrin depositions on the impeller as well as on the inner surface of the outflow graft without an impairment of pump function. Our results demonstrate that this newly developed microaxial blood pump is a promising device for RV support, but it cannot be driven without any anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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In Vivo Experimental Testing of a Microaxial Blood Pump for Right Ventricular Support

Christiansen

Pérez-Bouza²,

Reul³

et al. 2006

Artificial Organs

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“…[1][2][3][4][5] Although these devices are easy to implant, their successful management requires the commitment of a significant amount of time and resources. Transfer to "hub" facilities experienced with longterm ventricular assist device (VAD) support and heart transplantation increases therapeutic options available and may improve survival.…”

mentioning

confidence: 99%

Regional Referral System for Patients with Acute Mechanical Support: Experience at The Cleveland Clinic Foundation

González-Stawinski

Chang²,

Navia³

et al. 2006

ASAIO Journal

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Regional referral networks ("hub and spoke") have been created to facilitate the transfer of patients on mechanical circulatory support. Although individual centers report good success, overall outcomes have remained poor. We investigated whether preoperative variables influenced survival and could be used to help select patients best served by referral. A retrospective chart review was conducted on all patients transferred to our institution supported on cardiac assist devices. Between January 1995 and September 2003, 39 patients were received in transfer for continued care after the implantation of a cardiac assist device. Eighty-five percent of patients had the ABIOMED BVS 5000 implanted. The most common indication was postcardiotomy shock. Sixty-four percent of patients were not candidates for heart transplantation due to medical or social contraindications. The 30-day mortality of this group was 62%. Survivors had less comorbidity and were less likely to have complex surgeries, neurologic impairment, and multisystem organ failure when presenting to our center. Devices were weaned in 30% of cases. Only six patients (15%) were successfully transplanted, and five of these patients have done well at follow-up. Based on our experience, we believe that cardiogenic shock patients benefit from a regional referral system if they have not had complex cardiac surgical procedures or developed multisystem organ failure. Furthermore, there is a survival advantage when using long-term devices because this allows possible recovery or transplantation.

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Management of Cardiovascular Dysfunction after Cardiac Surgery

Metzler¹

2001

Critical Care Cardiology in the Perioperative Period

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Current strategy of temporary circulatory support for severe cardiac failure after operation

Cited by 22 publications

References 8 publications

In Vivo Experimental Testing of a Microaxial Blood Pump for Right Ventricular Support

In Vivo Experimental Testing of a Microaxial Blood Pump for Right Ventricular Support

Regional Referral System for Patients with Acute Mechanical Support: Experience at The Cleveland Clinic Foundation

Management of Cardiovascular Dysfunction after Cardiac Surgery

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