Survival and Complications Following Ventricular Assist Pumping for Cardiogenic Shock

Abstract

Thirty patients (pts) have undergone ventricular assist pumping for up to 25.4 days (mean 6.8 days). Twenty-eight pts could not be weaned from cardiopulmonary bypass (CPB) after open heart operations and two pts sustained myocardial infarctions (MI), with cardiogenic shock unresponsive to medical therapy previous to surgery. Twenty-two pts required left ventricular assistance (LVA); 55% (12/22) were weaned from the pump and 32% (7/22) survived. Two pts required right ventricular assistance (RVA); both were weaned from the pump and survived. Six pts required right and left ventricular assistance (BVA) and none survived. Postoperative survival for program years 1976 through 1979 (14 pts) was 14% (2/14). Postoperative survival for program years 1980 through 1982 (16 pts) was 44% (7/16), reflecting improved pump insertion techniques (left atrial cannulation) and pt management. Since 1980, 12 pts have required LVA, nine have been weaned from the pump, and six pts have survived (50%). One pt has required RVA and has survived, and three pts requiring BVA did not survive. Seven pts have been alive and well 5, 9, 14, 19, 24, 30 and 36 months after surgery. Five are NYHA functional Class I status and two pts are NYHA Class II status. Current data indicates that single ventricular assistance in pts who cannot be weaned from CPB is "reasonable and therapeutic treatment to extend life."

Effect of halothane on metabolism of 5-hydroxytryptamine by rat lungs perfused in situ

“…that clearance of 5-HT by perfused lungs removed from rats exposed to 100% oxygen was reduced; subsequent studies showed a similar depression of 5-HT uptake in cultured endothelial cells exposed to high oxygen tension (Block & Stalcup, 1981). Clinical observations (Pennock et al, 1977) suggested that lung injury during cardiopulmonary bypass led to modified lung function. Factors that might be implicated, in addition to hypoxia, include reduced or interrupted pulmonary flow, exposure to volatile anaesthetics or a combination of these conditions.…”

“…Structural and metabolic integrity of the pulmonary endothelium is required for normal lung function, including gas exchange, as well as the metabolic contributions of the lung to whole-body homoeostasis. Recent studies established the lung as an important site of metabolism of circulating drugs, peptides and vasoactive amines (Junod, 1977) and showed that these functions may be compromised by the variety of factors associated with lung injury (Seiler et al, 1976;Pennock et al, 1977;Fishman & Renkin, 1979). For example, hypoxia reduced the activity of angiotension-converting enzyme in the hydrolysis of angiotensin I to angiotensin II both in intact lungs of anaesthetized dogs (Leuenberger et al, 1978;Stalcup et al, 1979a) and in cultured endothelial cells (Stalcup et al, 1979b).…”

Total Artificial Heart and Assist Devices as a Bridge to Transplantation

“…Hemodynamically, the indication for ventricular assist, in some cases leading to bridging, is a low cardiac index with values of about 2 l/m 2/min, atrial pressures of about 20 to 25 mmHg and systolic blood pressure below 90 mmHg, provided that intra-aortic, balloon pumping (IASP) and cardiac drug treatment failed to improve the patients' situation (11).…”

The Spindle Pump—A Nonpulsatile Blood Pump for Assisted Circulation

“…Thanks to the continual improvement in operating techniques, the myriad of possibilities in myocardial protection, hypothermia and heart-lung machines, the 10% was reduced to about 4% [30][31][32][33]. Without treatment these patients develop low cardiac output syndrome and the cardiac index falls below the critical 2 liters/min/sq.…”

“…Its advan-tage was that it functioned like the natural heart, providing a pulsatile flow in comparison to the nearly non-pulsatile flow of the roller pump. Thereafter, numerous pump types with different propulsion systems and varying installation methods were considered, experimentally tested and also clinically applied [31,32,38,39,. This was mostly due to the physiological functions on one hand and the minimal blood strain on the other.…”