Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices

Joseph DeRose, Juan P. Umana, Michael Argenziano, Katharine A. Catanese, Howard R. Levin, Benjamin C. Sun, Eric A. Rose, Mehmet C. Oz

Research output: Contribution to journalArticle

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Abstract

Background. Over the past decade, the use of mechanical circulatory support in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40%. In an attempt to improve patient survival, we initiated a program of early insertion of an implantable Thermocardiosystems Incorporated Heartmate left ventricular assist device in patients who have circulatory failure after having undergone high-risk cardiac operations. Methods. Between April 1993 and February 1997, 12 patients underwent insertion of an implantable left ventricular assist device for postcardiotomy cardiogenic shock after coronary artery bypass grafting. Indications for insertion included postoperative cardiogenic shock (7 patients), postoperative cardiac arrest (3 patients), and failure to wean from cardiopulmonary bypass (2 patients). Results. The median time to device insertion was 3.5 days. The mean duration of left ventricular assist device support was 103 ± 19 days (range, 2 to 225 days). Nine of 11 patients (82%) survived to undergo either transplantation (8 patients) or explantation (1 patient), with successful hospital discharge of all 9 patients. The major complication was device-related infection (42%). A single thromboembolism occurred in a patient with an infection. Conclusions. Long-term outcome after postcardiotomy cardiogenic shock is improved substantially with the use of an implantable left ventricular assist device early in the postoperative course. Access to such a device is an important consideration before undertaking a high-risk cardiac operation, and early implantation of the device is a critical factor in ensuring long-term survival.

Original languageEnglish (US)
Pages (from-to)1757-1763
Number of pages7
JournalAnnals of Thoracic Surgery
Volume64
Issue number6
DOIs
StatePublished - Dec 1997
Externally publishedYes

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Heart-Assist Devices
Cardiogenic Shock
Equipment and Supplies
Survival
Thromboembolism
Infection
Heart Arrest
Cardiopulmonary Bypass
Coronary Artery Bypass
Shock
Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices. / DeRose, Joseph; Umana, Juan P.; Argenziano, Michael; Catanese, Katharine A.; Levin, Howard R.; Sun, Benjamin C.; Rose, Eric A.; Oz, Mehmet C.

In: Annals of Thoracic Surgery, Vol. 64, No. 6, 12.1997, p. 1757-1763.

Research output: Contribution to journalArticle

DeRose, Joseph ; Umana, Juan P. ; Argenziano, Michael ; Catanese, Katharine A. ; Levin, Howard R. ; Sun, Benjamin C. ; Rose, Eric A. ; Oz, Mehmet C. / Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices. In: Annals of Thoracic Surgery. 1997 ; Vol. 64, No. 6. pp. 1757-1763.
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abstract = "Background. Over the past decade, the use of mechanical circulatory support in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25{\%} to 40{\%}. In an attempt to improve patient survival, we initiated a program of early insertion of an implantable Thermocardiosystems Incorporated Heartmate left ventricular assist device in patients who have circulatory failure after having undergone high-risk cardiac operations. Methods. Between April 1993 and February 1997, 12 patients underwent insertion of an implantable left ventricular assist device for postcardiotomy cardiogenic shock after coronary artery bypass grafting. Indications for insertion included postoperative cardiogenic shock (7 patients), postoperative cardiac arrest (3 patients), and failure to wean from cardiopulmonary bypass (2 patients). Results. The median time to device insertion was 3.5 days. The mean duration of left ventricular assist device support was 103 ± 19 days (range, 2 to 225 days). Nine of 11 patients (82{\%}) survived to undergo either transplantation (8 patients) or explantation (1 patient), with successful hospital discharge of all 9 patients. The major complication was device-related infection (42{\%}). A single thromboembolism occurred in a patient with an infection. Conclusions. Long-term outcome after postcardiotomy cardiogenic shock is improved substantially with the use of an implantable left ventricular assist device early in the postoperative course. Access to such a device is an important consideration before undertaking a high-risk cardiac operation, and early implantation of the device is a critical factor in ensuring long-term survival.",
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AU - Levin, Howard R.

AU - Sun, Benjamin C.

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