Outcome of the Perioperative Use of Percutaneous Cardiopulmonary Support for Adult Cardiac Surgery: Factors Affecting Hospital Mortality

Abstract

Percutaneous cardiopulmonary bypass support (PCPS) has become a widespread standard modality for the treatment of circulatory collapse; however, its clinical use for postcardiotomy low cardiac output syndrome (LOS) has been reported to be unsatisfactory. We reviewed the clinical outcomes of twenty-three patients undergoing cardiac surgery and treated with PCPS. Solitary coronary artery grafting was undertaken for nine patients, while three had concomitant procedures. The remaining patients underwent valvular surgery. The indications for PCPS were preoperative shock in two patients and postcardiotomy LOS or shock in twenty-one patients. All patients except one underwent an intraaortic balloon pump. Sixteen of the twenty-three patients (69.6%) were weaned from PCPS and twelve patients (52.2%) reached hospital discharge. A univariate analysis revealed that risk factors for hospital mortality were age older than seventy years (P = 0.05), PCPS running time (P = 0.017), low cardiac function at the institution of PCPS (P = 0.004), and urine output within the initial 24 h (P = 0.041). The cardiac index (CI) in survivors was improved within 24 h, and eleven of the twelve survivors were weaned off PCPS within 48 h, whereas ten of the twelve nonsurvivors required PCPS for more than 48 h (P = 0.0006). There is little possibility of weaning patients from PCPS who do not show any signs of hemodynamic recovery within 48 h after its institution. Limited use of PCPS within 48 h may be applicable for postcardiotomy patients, but other cardiopulmonary support, such as a left ventricular assist device, may be required when hemodynamic recovery is not obtained within 48 h.

Implantation of left ventricular assist devices under extracorporeal life support in patients with heparin-induced thrombocytopenia

“…Pre-existing organ dysfunction is thought to unfavorably affect patient survival after VAD implantation (13). ECLS is a well-established technology that provides circulatory support with the possibility to recover from organ injury (3)(4)(5)(6)(7). Once hemodynamics is stabilized and organ function has recovered, long-term circulatory function can be maintained with an early bridge to univentricular or biventricular assist device.…”

“…In case of acute circulatory impairment with severe hemodynamic instability, multiorgan failure can appear which unfavorably affects survival after LVAD implantation. Extracorporeal life support (ECLS) is a well-established technique for quick and easy installable circulatory support that offers the opportunity of recoverment from such organ injury (3)(4)(5)(6)(7) prior to LVAD therapy. Once organ functions have been stabilized, longterm circulatory function can be sustained with an early bridge to uni-or biventricular assist device.…”

Short-term Mechanical Circulatory Support with a Centrifugal Pump - Results of Peripheral Extracorporeal Membrane Oxygenator According to Clinical Situation

“…Unless decompression of the left atrium is achieved, recovery of the left ventricle may be hindered [23]. If a better clinical manifestation is expected, aggressive use of IABP combined with use of PCPS should be considered for recovery of cardiac function [24]. …”

Circulatory Assistance and Surgery for Residual Pulmonary Hypertension Following Thromboendarterectomy

“…For duration to removal of PCPS, Oshima et al 5) noted that the PCPS assistance period for 32 patients with severe heart failure was 134 w 117 hours (5.58 w 4.88 days) on average. Murashita et al 6) noted that patients who could be removed from PCPS were included in a group with an assistance period of 24 hours or less. In our case, it was 3.33 w 2.42 days for group P, the same as the assistance period for common cardiac failure therapy.…”