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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bart P. Meyns Paul T. Sergeant Willem J. Daenen Willem J. Flameng Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Meyns, B. P. Articles by Flameng, W. J. Search for Related Content PubMed Articles by Meyns, B. P. Articles by Flameng, W. J. Related Collections Related Article

Ann Thorac Surg 1996;62:500
© 1996 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of Cardiac Surgery, Gasthuisberg University Hospital, Leuven, Belgium,

See also page 495.

The experiences of Dr Peterzén and colleagues have contributed toward the growing trust in the transthoracic Hemopump. This transthoracic cannula proves again to be a reliable and powerful left ventricular assist device. Also, in our experience with more than 30 clinical implantations of the transthoracic cannula, we experienced no important technical problems [1]. In addition, this Hemopump is easy to handle and cheaper than the more complex pulsatile devices. The nonpulsatility of the produced flow does not seem to affect the organ perfusion or function, at least during the short pump runs in these clinical experiences. We have shown this experimentally in a sheep model (unpublished results), and the clinical results further confirm this. In addition, it is important to appreciate that the hemodynamic status in the Hemopump-assisted situation still remains dependent on the heart itself. The Hemopump and heart influence each other strongly, and this Hemopump–heart interaction therefore changes as soon as the heart starts to recover.

The most interesting issue addressed by this article is the indication for the use of the Hemopump. The patients reported in this series were immediately treated with the Hemopump. The less invasive and cheaper intraaortic balloon pump was considered to be insufficient. Up to now most clinicians have been reluctant to induce "prophylactic" mechanical support and waited to implant any device until it was clear that the patient really could not do without it. This attitude is understandable as the insertion of most assist devices is a major procedure and the use of the device itself carries a certain morbidity. On the other hand, the extensive clinical experience with the intraaortic balloon pump has shown that 50% of these patients assisted for postcardiotomy heart failure die. Thanks to technical improvements and identification of high-risk patients, the indications for intraaortic balloon counterpulsation have changed over time. We originally used the intraaortic balloon only in high-risk patients (those with main stem lesions). Later the indication was extended to any patient in postcardiotomy heart failure. Now, the intraaortic balloon pump is often used prophylactically as well as in the nonsurgical setting. Similar to this evolution in intraaortic balloon pump use, our clinical practice has moved toward earlier Hemopump support. We decided to use the Hemopump immediately in patients brought to the operating room in hemodynamic shock and with hemorrhagic myocardial infarction. In addition, we have experimental evidence that the association of the intraaortic balloon pump with the Hemopump combines both advantages: unloading of the heart and increasing myocardial perfusion.

Two major advances can guide us to delineate the indications of the Hemopump. The first is better identification of high-risk patients in postcardiotomy heart failure with growing experience. Baldwin and associates [2] identified advanced age, female sex, pacing requirement, and the preoperative blood urea nitrogen levels as risk factors. Further, patients with preoperative bad ventricular function, hemodynamic shock, and major acute myocardial infarction are at a higher risk. Second, more recent technical innovations might offer another solution. The small rotary blood pump, introducible through the groin with the same power and reliability as this transthoracic Hemopump, appears to be promising. It opens the field of prophylactic unloading of the myocardium without increasing risks.

References

1. Meyns B, Sergeant P, Daenen W, Flameng W. Left ventricular assistance with the transthoracic 24F Hemopump for recovery of the failing heart. Ann Thorac Surg 1995;60:392–7.[Abstract/Free Full Text]
2. Baldwin RT, Slogoff S, Noon GP, et al. A model to predict survival at time of postcardiotomy intraaortic balloon insertion. Ann Thorac Surg 1995;55:908–13.[Abstract]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bart P. Meyns Paul T. Sergeant Willem J. Daenen Willem J. Flameng Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Meyns, B. P. Articles by Flameng, W. J. Search for Related Content PubMed Articles by Meyns, B. P. Articles by Flameng, W. J. Related Collections Related Article