Mechanical circulatory support with the thoratec assist device in patients with postcardiotomy cardiogenic shock

Background. In spite of modem cardiac surgical techniques, severe cardiogenic shock not responding to pharmacologic therapy and intraaortic balloon pumping develops in about 0.2% to 1.2% of patients undergoing cardiac operations. Methods. From September 1987 to September 1994, 184 patients were supported with different mechanical circulatory support systems. Nine patients with postcardiotomy cardiogenic shock were supported with the Thoratec ventricular assist device. Four patients suffered early postcardiotomy cardiogenic shock, and 5 patients suffered late postcardiotomy cardiogenic shock. In 6 patients the Thoratec device was applied exclusively, in 2 patients both Bio-Medicus and Thoratec, and in 1 patient both ABIOMED and Thoratec devices were used. Duration of support ranged from 5 to 46 days with a mean duration of 15 days. Results. Four patients (44%) survived and were discharged. Main complications and causes of death were multiple organ failure and sepsis. Conclusions. The results justify the use of Thoratec assist device in patients with severe preoperative cardiogenic shock.