Ventricular-Assist Pumping in Patients with Cardiogenic Shock after Cardiac Operations

A ventricular-assist pump was used to support the circulation in eight patients who could not be separated from cardiopulmonary bypass after open-heart operations. In five patients with left ventricular failure, the systemic circulation was maintained with pumping from the left ventricle or left atrium to the aorta for 7.0±1.8 days (mean ±S.E.M.); three of these patients were well four to 17 months after surgery. In two patients with biventricular failure, right and left ventricular bypass supported the circulation, but neither patient survived. One other patient had isolated right ventricular failure; pumping from the right atrium to the pulmonary artery maintained the pulmonary circulation for 2.2 days. This patient lived for 18 months. Use of the ventricular-assist pump in our patients provided complete support of the systemic or pulmonary circulation or both. Profoundly depressed ventricular function is potentially reversible if technical problems in employing the pump can be avoided. (N Engl J Med. 1981; 305:1606–10.). PROFOUND refractory heart failure remains a major cause of death in patients at high risk after cardiac surgery. The intra-aortic balloon has been used as a form of mechanical circulatory assistance in these patients when volume augmentation and pharmacologic therapy have been unsuccessful in allowing the patient to be separated from cardiopulmonary bypass. However, half these patients die from cardiogenic shock despite counterpulsation with the intra-aortic balloon.¹ Therefore, there is a need for a form of mechanical circulatory support that is capable of maintaining the systemic circulation and unloading the left ventricle while myocardial function recovers. Five years ago, several. . .