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

Abstract

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.

Implantable Left Ventricular Assist Devices

“…The second group consists of patients with myocardial infarction, acute myocarditis, or end-stage heart disease who are not expected to recover adequate cardiac function and who require mechanical support as a bridge to transplantation. [19][20][21][22] The available ventricular assist devices include extracorporeal membrane oxygenation, univentricular and biventricular extracorporeal nonpulsatile devices, extracorporeal and implantable pulsatile devices, and the total artificial heart ( Table 1). Although most of these devices require the patient to be connected to cumbersome extracorporeal drive systems, miniaturization of control and power-supply components has resulted in the development of wearable left ventricular assist devices.…”

Implantation of the Left Ventricular Assist Device

“…The largest series of clinical LVAD applications with pulsatile devices have been reported by Pierce,a Pennington,e andBernhardJo Between 1980 and1985, Pierce and Donachy at Hershey University have applied their device in 21 patients: 11 patients could be weaned off and 9 patients were discharged. Pennington's group at St. Louis University has used the same device in 34 postcardiotomy patients: 10 patients could be weaned off the device and 7 were long-term survivors.…”

Glycoprotein IIb/IIIa Receptor Inhibitor Attenuates Platelet Aggregation Induced by Thromboxane A2 During In Vitro Nonpulsatile Ventricular Assist Circulation

“…However, because the source of organ donors for heart transplantation is limited, ventricular assist devices (VADs) have been used for circulatory support prior to transplantation. VADs are also used for temporary hemodynamic support in patients with postcardiotomy (2) or postinfarction low output syndromes (3). Unfortunately, the use of these devices may be complicated by initial bleeding and later thromboembolism.…”