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The Journal of Cardiovascular Surgery 1999 October;40(5):627-31

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Methods of acute postcardiotomy left ventricular assistance

Reardon M. J., Conklin L. Dl., Letsou G. V., Safi H. J., Espada R., Baldwin J. C.

From the Department of Surgery Baylor College of Medicine Methodist Hospital, Houston, Texas, USA


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Objec­tive. ­Despite ­many tech­no­log­ical ­advances in car­di­o­vas­cular sur­gery, ­some ­patients ­still expe­ri­ence post­car­di­otomy ­left ven­tric­ular (LV) ­failure ­that is refrac­tory to ­both ­inotropic sup­port and ­intra-­aortic bal­loon ­pump (­IABP) place­ment. The pri­mary ­author (MJR) ­recently ­changed ­from ­inflow can­nu­la­tion at the ­right ­superior pul­mo­nary ­vein/­left ­atrial junc­tion to ­inflow can­nu­la­tion at the ­dome of the ­left ­atrium. The pur­pose of ­this ­study was to com­pare ­data col­lected ­during place­ment of a ­left ven­tric­ular ­assist ­device (­LVAD) at the junc­tion of the ­right ­superior pul­mo­nary ­vein ­with posi­tioning the ­device in the ­dome of the ­left ­atrium. Experi­mental ­design, set­ting, and par­tic­i­pants: the med­ical ­records of all ­patients under­going car­diac sur­gery by one ­author (MJR) ­between 1994 and 1997 ­were ret­ro­spec­tively ­reviewed, and 4 ­patients ­requiring ­LVAD place­ment for ­short ­term post­car­di­otomy sup­port ­were iden­ti­fied. ­Each ­patient’s ­chart was ­reviewed for dura­tion of ­LVAD sup­port, ­average ­LVAD ­blood ­flows, pul­mo­nary cap­il­lary ­wedge pres­sures (­PCWP), pre­op­er­a­tive char­ac­ter­is­tics, post­op­er­a­tive com­pli­ca­tions, and ­final out­come for the ­patients.
­Results. ­Accessing the ­left ­atrium ­through the ­dome ­resulted in excel­lent ­blood ­flow ­through the ­LVAD and ­allowed for ­good LV decom­pres­sion. Hemo­stasis ­remained the ­most ­common com­pli­ca­tion regard­less of the tech­nique ­employed; how­ever, the ­enhanced vis­ibility pro­vided by ­accessing the ­left ­atrium via the ­dome ­made ­repairs ­less tech­ni­cally dif­fi­cult. ­Three ­patients (75%) ­were ­able to be ­weaned ­from the ­LVAD and ­were dis­charged ­from the hos­pital to ­home. Two of ­these ­patients ­were can­nu­lated via the ­left ­atrial ­dome ­making ­removal of the ­LVAD ­easier, ­thus ­exposing the ­patients to ­less addi­tional oper­a­tive ­time. One ­patient ­could not be ­weaned ­from ­LVAD sup­port sec­on­dary to devel­op­ment of ­right ven­tric­ular ­failure ­requiring ­RVAD inser­tion and sub­se­quent devel­op­ment of mul­tiple ­organ ­failure syn­drome.
Con­clu­sions. ­Patients ­requiring LV assis­tance fol­lowing car­di­o­pul­mo­nary ­bypass sur­gery tra­di­tion­ally ­have ­high ­levels of mor­bidity and mor­tality. In ­spite of the com­pli­ca­tions asso­ciated ­with the place­ment of an ­assist ­device, we ­remain encour­aged by the excel­lent LV decom­pres­sion and ­systemic ­flows we ­achieved fol­lowing implan­ta­tion of the ­LVAD ­through the ­dome of the ­left ­atrium. The ­superior ­ease of implan­ta­tion and decan­nu­la­tion pro­vided ­better oper­a­tive ­care and post­op­er­a­tive man­age­ment for our ­patients.

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