Survival and complications following ventricular assist pumping for cardiogenic shock.

Abstract

Thirty patients (pts) have undergone ventricular assist pumping for up to 25.4 days (mean 6.8 days). Twenty-eight pts could not be weaned from cardiopulmonary bypass (CPB) after open heart operations and two pts sustained myocardial infarctions (MI), with cardiogenic shock unresponsive to medical therapy previous to surgery. Twenty-two pts required left ventricular assistance (LVA); 55% (12/22) were weaned from the pump and 32% (7/22) survived. Two pts required right ventricular assistance (RVA); both were weaned from the pump and survived. Six pts required right and left ventricular assistance (BVA) and none survived. Postoperative survival for program years 1976 through 1979 (14 pts) was 14% (2/14). Postoperative survival for program years 1980 through 1982 (16 pts) was 44% (7/16), reflecting improved pump insertion techniques (left atrial cannulation) and pt management. Since 1980, 12 pts have required LVA, nine have been weaned from the pump, and six pts have survived (50%). One pt has required RVA and has survived, and three pts requiring BVA did not survive. Seven pts have been alive and well 5, 9, 14, 19, 24, 30 and 36 months after surgery. Five are NYHA functional Class I status and two pts are NYHA Class II status. Current data indicates that single ventricular assistance in pts who cannot be weaned from CPB is "reasonable and therapeutic treatment to extend life."