Revista espanola de anestesiologia y reanimacion · 2001
[Ventricular assist support of the failing heart after surgery with extracorporeal circulation].
Клиническое исследованиеАннотация на английскомСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Rivera Gaitero J, Domínguez Rico E, Plaza Mardomingo A
Аннотация
OBJECTIVE: To communicate our experience implanting ventricular assist devices; we report the incidence of refractory heart failure after extracorporeal circulatory support and discuss clinical course after support.
PATIENTS AND METHOD: Retrospective study of 14 cases of ventricular assistance required when refractory heart failure developed after extracorporeal circulation. The patients were 10 males and 4 females aged between 12 and 70 years. Four underwent coronary revascularization, 2 required valve replacement, and 8 received heart transplants. Two left, 2 right and 6 bilateral ventricular assist devices were implanted.
RESULTS: The incidence of refractory heart failure after extracorporeal mechanical circulation requiring ventricular assist devices among our patients was 0.48%, with left ventricular failure occurring in 21.42%, right ventricular failure in 42.85% and biventricular failure in 35.71%. The main complications were infection, renal insufficiency, coagulation disorder, hemorrhage with repeated surgery. One patient received a second transplant. The device was successfully withdrawn from 35.7% of the patients. Survival upon discharge was 7.1%.
CONCLUSION: Refractory heart failure after extracorporeal circulation is a life-threatening event requiring rapid response and resolution. The decision to implant a ventricular assist device is a difficult one, requiring immediate assessment of the causes of heart failure, its reversibility and the possibility of performing a heart transplant. The study of large series of patients experiencing this event and implanted with ventricular assist devices would facilitate decision making.
PATIENTS AND METHOD: Retrospective study of 14 cases of ventricular assistance required when refractory heart failure developed after extracorporeal circulation. The patients were 10 males and 4 females aged between 12 and 70 years. Four underwent coronary revascularization, 2 required valve replacement, and 8 received heart transplants. Two left, 2 right and 6 bilateral ventricular assist devices were implanted.
RESULTS: The incidence of refractory heart failure after extracorporeal mechanical circulation requiring ventricular assist devices among our patients was 0.48%, with left ventricular failure occurring in 21.42%, right ventricular failure in 42.85% and biventricular failure in 35.71%. The main complications were infection, renal insufficiency, coagulation disorder, hemorrhage with repeated surgery. One patient received a second transplant. The device was successfully withdrawn from 35.7% of the patients. Survival upon discharge was 7.1%.
CONCLUSION: Refractory heart failure after extracorporeal circulation is a life-threatening event requiring rapid response and resolution. The decision to implant a ventricular assist device is a difficult one, requiring immediate assessment of the causes of heart failure, its reversibility and the possibility of performing a heart transplant. The study of large series of patients experiencing this event and implanted with ventricular assist devices would facilitate decision making.