Journal of cardiac surgery
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Despite the many advances in the management of patients with acute heart failure, the outcome for patients with refractory acute cardiogenic shock remains disproportionately poor. Clearly, there is a definitive role for wider application of temporary circulatory support in such patients. ⋯ There are currently several options available for circulatory support and include surgically implanted ventricular assist devices, percutaneous assist devices, and extracorporeal membrane oxygenation. This review includes a brief summary of the current assist devices available along with the University of Minnesota's experience with the Levitronix CentriMag system.
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Postcardiotomy cardiogenic shock (PCCS) complicates 0.2% to 6% of cardiac operations and is a clinical entity fraught with considerable morbidity and mortality. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. ⋯ Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center.
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Cardiogenic shock following acute myocardial infarction affects 5% to 10% of patients and carries a grave prognosis. The dismal prognosis associated with post-MI cardiogenic shock, allied with surgical and technological advancements, has shifted the treatment paradigm toward wider use of mechanical circulatory support devices (MCSD). ⋯ However, perceived limitations with existing devices mean that they remain infrequently applied. There is an urgent need for increased awareness of MCSD options among clinicians treating post-MI shock patients.
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Review Historical Article
Transcutaneous energy transmission for mechanical circulatory support systems: history, current status, and future prospects.
A totally implantable mechanical circulatory support system would be very desirable for destination therapy. However, implanting all components of a pulsatile total artificial heart (TAH) or left ventricular assist device (LVAD) is complex because of the requirement for a continuous electrical power supply and the need for volume compensation. Implantable compliance chambers were developed for early LVAD designs, and although they functioned properly during initial laboratory tests, air loss by diffusion and the development of fibrous tissue around the sac eventually rendered them ineffective. ⋯ More recently, TETSs were used clinically for both a pulsatile TAH and LVAD in a small number of patients, but for reasons unrelated to the TETS, neither of these devices is presently in use. Because the newer continuous-flow LVADs do not require a compliance chamber, they present a potential future application for TETS technology, because infections of the percutaneous tube continue to be one of the most important limitations of long-term circulatory support. A totally implantable LVAD with an incorporated TETS for destination therapy could become an important advance in the treatment of end-stage heart failure.
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Pulsatile flow left ventricular assist devices (PF-LVADs) have successfully supported patients with severe heart failure for bridge-to-transplant (BTT) and destination therapy (DT). End-organ dysfunction is often reversed, optimizing the patient's condition to enhance survival, and quality of life. Questions have been raised regarding the potential for continuous flow LVADs (CF-LVADs) to provide the same quality of circulatory support. ⋯ There are anecdotal cases of patients being supported with a CF-LVAD for over seven years with preserved end-organ function. Presently, there are no clinical reports indicating that end-organ function is not well maintained. Current clinical evidence indicates that end-organ perfusion and function can be well maintained for extended durations of support with a CF-LVAD.