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This Article Full Text (PDF) 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): Mehmet C. Oz Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Oz, M. C. Search for Related Content PubMed Articles by Oz, M. C. Related Collections Mechanical Circulatory Assistance Related Article

Ann Thorac Surg 2001;72:2055
© 2001 The Society of Thoracic Surgeons

Invited commentary

^a Department of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, MHB 7-435, 177 Fort Washington Ave, New York, NY 10032, USA

e-mail: mco2{at}columbia.edu

Experience gained from patients supported with Bio-Medicus pump systems should not be extrapolated directly to cohorts managed with more advanced ventricular support systems. As a result, several fundamental lessons learned with the implantation of longer-term wearable systems, such as the Heartmate or Novacor devices, are violated by the advice gained by the authors using only Biomedicus short-term devices. In particular, conclusions on the safety of specific strategies to manage prosthetic valves should be avoided as the support times in experiences such as those reported by Dr Tisol and his colleagues are very short and poorly predict longer-term experiences. For example, as only a single Thoratec system was implanted, no substantive comments should be made by the authors on the efficacy or limitations of this widely-used device.

Contrary to common practice, the authors advocate reduced left ventricular device flows in the early postoperative period. At this critical juncture, these patients usually have end organ dysfunction and demand maximal unloading of the left ventricle for optimal recovery. By purposely reducing pump flows in order to preserve regular opening of the patient’s native valves, are the authors sacrificing long-term survival? Alternative approaches to this complex problem, including oversewing the valves have been advocated in larger series [1]. This issue becomes important when one discusses the application of this technique to a longer-term device support cohort, especially since stable anticoagulation can be challenging in this setting.

With these concerns in mind, we divide our patients with valve prostheses who are suffering from cardiogenic shock into two categories. For patients in whom ventricular recovery is anticipated, left ventricular cannulation for device inflow will preserve blood flow across a mitral prostheses and will decompress the ventricle optimally. The aortic valve is prone to thrombus formation due to erratic opening pressures, so anticoagulation is essential even if the device flow is reduced. However, if longer-term device support is required, we strongly advocate permanent closure of the aortic valve using a circular dacron patch attached to the annulus. This removes the need for anticoagulation and provides a more practical and safer treatment option for patients undergoing insertion of implantable devices.

References

1. Rao V., Slater J.P., Edwards N.M., Naka Y., Oz M.C. Surgical management of valvular disease in patients requiring left ventricular assist device support. Ann Thorac Surg 2001;71:1448-1453.[Abstract/Free Full Text]

This Article Full Text (PDF) 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): Mehmet C. Oz Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Oz, M. C. Search for Related Content PubMed Articles by Oz, M. C. Related Collections Mechanical Circulatory Assistance Related Article