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Ann Thorac Surg 2001;71:S56-S59
© 2001 The Society of Thoracic Surgeons
a Department of Surgery, East Tennessee State University, Johnson City, Tennessee, USA
b Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
d Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
e Division of Cardiothoracic Surgery, University of Missouri, Columbia, Missouri, USA
f Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
Address reprint requests to Dr Pennington, Department of Surgery, East Tennessee State University, PO Box 70575, Johnson City, TN 37614
e-mail: penningg{at}etsu.edu
Presented at the Fifth International Conference on Circulatory Support Devices for Severe Cardiac Failure, New York, NY, Sept 15–17, 2000.
Abstract
Circulatory support devices are frequently required in postcardiotomy shock, postmyocardial infarction shock, and acute myocarditis. A panel of cardiac surgeons addressed the use of these devices in 4 patients. Cardiogenic shock after mitral valve replacement was considered best served by a left ventricular assist device (VAD) with apical rather than atrial cannulation. A left VAD should be placed first and a right VAD only if needed. Acute myocardial infarction shock was considered best treated with a left VAD with left ventricular cannulation to avoid thrombosis. If cardiac transplantation is an option, a long-term device must be considered. Young patients with acute fulminant myocarditis should be implanted with VADs in anticipation of recovery, and transplantation should be delayed. Patients with severe heart failure after coronary bypass grafting were considered best served by an extracorporal membrane oxygenation (ECMO) system or a VAD. Current postcardiotomy survival rates of postcardiotomy patients of 20% to 40% are worthwhile, but can be improved. Temporary devices such as ECMO can be changed to more long-term devices when necessary.
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