Abstract :
Background.
Postcardiotomy cardiogenic shock remains a challenging situation. Many devices can be used although none of them directly unlead the left ventricle except for the Hemopump. We report our clinical experience with the Hemopump 31 or sternotomy Hemopump.
Methods.
From 1992 to 1994, 15 patients received a Hemopump 31. All suffered postcardiotomy cardiogenic shock either after coronary artery bypass grafting (n = 14) or after heart transplantation (n = 1). Patients enrolled had refractory heart failure despite the use of optimal inotropic support. Three groups can be identified: group 1 (n = 2 patients), double Hemopump right and left; group 2 (n = 4), patients with delayed insertion after intraaortic balloon pump failure; and group 3 (n = 9 patients), immediate insertion. The average support of duration for the survivors was 5 days.
Results.
No mechanical failure or device-related complication was noticed. There were striking differences between groups 1 and 2 as opposed to group 3, as only 1 patient survived in group 2 and none in group 1, as opposed to 5 patients in group 3. Overall survival is 40%. All patients were discharged from the hospital.
Conclusions.
Factors showing adverse effect are biventricular failure, vasoconstrictor requirement, and delayed insertion. We believe the Hemopump is a more efficient device than the intraaortic balloon pump, and that early use after onset of heart failure achieves better results.
