Mechanical Circulatory Assistance

Abstract

EACH YEAR MORE than 600,000 people in this country die from coronary artery disease. It has been estimated that more than half of this number could be saved and returned to a productive life through the prompt application of either temporary or permanent forms of mechanical circulatory assistance (MCA).' Such a projection presumes that a means to detect life-threatening events can be devised and that effective devices to support the circulation can be fabricated. In the former instance, identification and delivery of patients at risk to treatment centers must await the development of a comprehensive health care system based on public education, triage centers, and sophisticated technology capable of predicting or detecting potentially serious cardiac events. By contrast, the methodology to support the failing circulation on a temporary basis is already a reality and has been since the cardiopulmonary-bypass machine was first used successfully for open-heart surgery in 1953.2 However, because of extensive bloodelement destruction accompanying prolonged use, cardiopulmonary bypass has been limited to a time frame exceeding no more than a few hours.3 To circumvent this limitation and also to explore new approaches with equal effec-

Acute Mechanical Complications of Coronary Arterial Disease

“…Careful attention is paid to left atrial pressure and the maintenance of a normal serum potassium level. If IABP is needed postoperatively, the patient is slowly weaned off IABP when the left atrial pressure can be maintained at 20 mm Hg or less and there is clinical evidence of adequate cardiac Accepted for publication April 3,1974 Figure) with ages ranging from 51 to 68 years, were seen in acute left ventricular failure 11 to 63 days following in¬ farction. In each, medical therapy was unsuccessful.…”