Ventricular Assistance: The Pennsylvania State University Experience

Abstract

Profound ventricular failure after cardiac operations occurs in nearly 4% of patients [1]. Fortunately, with the appropriate use of volume loading, inotropic, vasodilator, and intra-aortic balloon support, about 70% of these patients can be weaned from cardiopulmonary bypass. A small percentage, however, are unresponsive to this conventional therapy and will die in the operating theater unless a more aggressive form of circulatory support is available. During the last decade, the relative safety and efficacy of temporary mechanical ventricular support for postcardiotomy cardiogenic shock has been demonstrated by investigators using various ventricular support systems. Ventricular recovery and hospital discharge have been reported in as many as 35%–45% of those patients who, otherwise, would have been expected to die [2–9]. Even more encouraging are recent reports that cardiac function and quality of life are excellent in long-term survivors following their hospital discharge [3, 4, 6, 8–10]. During the same 10-year period, there has been renewed interest in cardiac transplantation, which considerably prolongs the lives of patients with end-stage cardiomyopathy. This interest and these improved results, however, have increased the number of centers and procedures, so that donor organs have become less available. Since the prognosis for survival of these patients without transplantation is less than 1 year, the arrival of a suitable donor organ before the patient’s demise is of obvious importance.