Left ventricular assistance with the centrifugal pump: management of the patient with stunned myocardium.

Prompt left ventricular assistance by the centrifugal pump enables the survival of many patients with postoperative low cardiac output who cannot be weaned from cardiopulmonary bypass with the aid of balloon counterpulsation and inotropic agents. Successful weaning from the centrifugal pump, however, depends on the careful selection of appropriate candidates as well as the strict control of pump flow, oncotic pressure, coagulopathy, blood pressure, and systemic afterload. The installation of a hemoconcentration device into the pump line helps control hemodilution and maintain adequate oncotic pressure. The management of a patient who was totally dependent upon left ventricular assistance is described.