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International Practice in Cardiothoracic Surgery pp 195–207Cite as

Postoperative Circulatory Support with a Pulsatile Assist Pump

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Abstract

About 5 % of cardiotomy patients cannot be weaned from cardiopulmonary bypass (CPB) following open heart operation.[1] These patients demonstrate profound heart failure which will, in most instances, respond to conventional therapy consisting of volume loading, inotropic support, and intra-aortic balloon (IAB) counterpulsation. One-quarter of all individuals with postcardiotomy cardiogenic shock do not respond to “conventional” therapy and require a more effective form of temporary circulatory support.[1] Pulsatile ventricular assist devices provide such support by reducing pressure work during systole, thereby decreasing myocardial oxygen consumption. In addition, a left ventricular assist device (LVAD) can pump enough blood to maintain adequate systemic perfusion and coronary blood flow, thereby providing time for the metabolic recovery of injured myocardium. A right ventricular assist device (RVAD) serves to decompress the right heart, maintain flow through the pulmonary vasculature, and volume load the left ventricle.

The authors gratefully acknowledge the assistance of Wayne E. Richenbacher, James H. Donachy, Gerson Rosenberg, Donald L. Landis, William J. Weiss, Paul E. Beard, Lynford T. Reichert, George Felder, James H. Donachy, Jr., G. Allen Prophet and Kay Holtzman, and the secretarial assistance of Sharon Smith.

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References

  1. Myers JL, Parr GVS, Pae WE Jr, Waldhausen JA, Pierce WS.: The role of the ventricular assist pump for postcardiotomy cardiogenic shock. A four and one-half year experience. Proceedings of the Third Meeting of ISAO. Artif Organs 5 (Suppl): 244–251, 1981.

    Google Scholar 

  2. Liotta D, Hall CW, Walter SH, Cooley DA, Crawford ES, DeBakey ME.: Prolonged assisted circulation during and after cardiac or aortic surgery. Prolonged partial left ventricular bypass by means of intracorporea l circulation. Am J Cardiol 12: 399–405, 1963.

    Article  PubMed  CAS  Google Scholar 

  3. Rose DM, Colvin SB, Culliford AT, Cunningham JN, Adams PX, Glassman E, Isom OW, Spencer FC.: Long-term survival with partial left heart bypass following perioperative myocardial infarction and shock. J Thorac Cardiovasc Surg 83: 483–492, 1982.

    PubMed  CAS  Google Scholar 

  4. Golding LR, Jacobs G, Groves LK, Gill CC, Nosé Y, Loop FD.: Clinical results of mechanical support of the failing left ventricle. J Thorac Cardiovasc Surg 83: 597–601, 1982.

    PubMed  CAS  Google Scholar 

  5. Pennington DG, Merjavy JP, Swartz MT, Willman VL.: Clinical experience with a centrifugal pump ventricular assist device. Trans Am Soc Artif Intern Organs XXVIII: 93–99, 1982.

    Google Scholar 

  6. Bernhard WF.: Clinical evaluation of ventricular assist devices. Report from Children’s Hospital Medical Center Cardiovascular Surgical Research Laboratory, Boston, Mass. Devices and Technology Branch (NHLBI) Contractors Meeting: 23, 1981.

    Google Scholar 

  7. Olsen EK, Pierce WS, Donachy JH, Landis DL, Rosenberg G, Phillips WM, Prophet GA, O’Neill MJ, Waldhausen JA.: A two and one-half year clinical experience with a mechanical left ventricular assist pump in the treatment of profound postoperative heart failure. Int J Artif Organs 2: 197–206, 1979.

    PubMed  CAS  Google Scholar 

  8. Pierce WS, Parr GVS, Myers JL, Pae WE Jr, Bull AP, Waldhausen JA.: Ventricular-assist pumping in patients with cardiogenic shock after cardiac operations. N Engl J Med 305: 1606–1610, 1981.

    Article  PubMed  CAS  Google Scholar 

  9. Pierce WS, Donachy JH, Landis DL, Brighton JA, Rosenberg G, Migliore JJ, Prophet GA, White WJ, Waldhausen JA.: Prolonged mechanical support of the left ventricle. Circulation (Suppl 1 ) 58: 133–146, 1978.

    Google Scholar 

  10. Kennedy JW, Kaiser GC, Fisher LD, Maynard C, Fritz JK, Myers W, Mudd JG, Ryan TJ, Coggin J.: Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). J Thorac Cardiovasc Surg 80: 876–887, 1980.

    PubMed  CAS  Google Scholar 

  11. Bernhard WF, Berger RL, Stetz JP, Carr JG, Colo NA, McCormick JR, Fishbein MC.: Temporary left ventricular bypass: Factors affecting patient survival. Circulation (Suppl 1 ) 60: 131–141, 1979.

    Google Scholar 

  12. Hilton CJ, Teubl W, Acker M, Levinson HJ, Millard RW, Riddle R, McEnany MT.: Inadequate cardioplegic protection with obstructed coronary arteries. Ann Thorac Surg 28: 323–334, 1979.

    Article  PubMed  CAS  Google Scholar 

  13. Kloner RA, DeBoer LWV, Darsee JR, Ingwall JS, Hale S, Tumas J, Braunwald E.: Prolonged abnor-malities of myocardium salvaged by reperfusion. Am J Physiol 240: H591–H599, 1981.

    Google Scholar 

  14. Sturm JT, Bossart MI, Holub DA, Milam JD, Norman JC.: Ultrastructural analyses of stone heart syndrome at onset and six days later following total support of the circulation with a partial artificial heart or left ventricular assist device (ALVAD). Cardiovascular Disease Bulletin of the Texas Heart Institute 6: 29–43, 1979.

    Google Scholar 

  15. Foglia RP, Lazar HL, Steed DL, Follette DM, Manganaro AJ, Deland E, Buckberg GD.: Iatrogenic myocardial edema with crystalloid primes: Effects on left ventricular compliance, performance and perfusion. Surgical Forum 29: 312–315, 1978.

    PubMed  CAS  Google Scholar 

  16. Buxton AE, Goldberg S, Harken A, Hirshfield J Jr, Kastor JA.: Coronary artery spasm immediately after myocardial revascularization: Recognition and management. N Engl J Med 304: 1249–1253, 1981.

    Article  PubMed  CAS  Google Scholar 

  17. Kloner RA, DeBoer LWV, Darsee JR, Ingwall JS, Hale S, Braunwald E.: Recovery of cardiac function and adenosine triphosphate requiring 7 days of reperfusion following 15 minutes of ischemia. Clinical Research 29: 562A, 1981.

    Google Scholar 

  18. Pierce WS.: Clinical left ventricular bypass: Problems of pump inflow obstruction and right ventricular failure, asaio J 2: 1–9, 1979.

    Google Scholar 

  19. Miller DC, Moreno-Cabral RJ, Stinson EB, Shinn JA, Shumway NE.: Pulmonary artery balloon coun-terpulsation for acute right ventricular failure. J Thorac Cardiovasc Surg 80: 760 — 763, 1980.

    PubMed  CAS  Google Scholar 

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Authors
  1. William S. Pierce
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  2. John A. Waldhausen
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Editor information

Editors and Affiliations

  1. Beijing Heart, Lung and Blood Vessel Medical Center, Beijing, China

    Yingkai Wu MB. ChB. (Professor of Thoracic Surgery) (Professor of Thoracic Surgery)

  2. University of California at San Diego, California, USA

    Richard M. Peters M.D. (Professor of Surgery & Biomedical Engineering) (Professor of Surgery & Biomedical Engineering)

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© 1986 Science Press, Beijing and Martinus Nijhoff Publishers, Dordrecht

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Pierce, W.S., Waldhausen, J.A. (1986). Postoperative Circulatory Support with a Pulsatile Assist Pump. In: Wu, Y., Peters, R.M. (eds) International Practice in Cardiothoracic Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4259-2_20

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  • DOI: https://doi.org/10.1007/978-94-009-4259-2_20

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-8391-1

  • Online ISBN: 978-94-009-4259-2

  • eBook Packages: Springer Book Archive

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