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J Thorac Cardiovasc Surg 2007;133:577-578
© 2007 The American Association for Thoracic Surgery

Brief Communication

Elective transfer from cardiopulmonary bypass to centrifugal blood pump support in very high-risk cardiac surgery

Stephen Westaby, BSc, FRCS, MS, PhD, FETCS, FESC, FACC, FICA*, Lognathen Balacumaraswami, MBBS, FRCS, FRCS (CTh), Betsy J. Evans, MRCS, Gabriele B. Bertoni, MD, Xu Y. Jin, MD, PhD, Desiree Robson, RN, Catherine R. Grebenik, MD

John Radcliffe Hospital, Oxford, UK.

Received for publication September 8, 2006; accepted for publication September 28, 2006.

* Address for reprints: Stephen Westaby, FRCS, MS, PhD, FETCS, FESC, FACC, FICA, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK. (Email: swestaby@ahf.org.uk).

The first 20% of the full text of this article appears below.


Figure 1
Drs Jin, Balacumaraswami, Westaby, Bertoni, Evans, and Grebenik (left to right)


Operations on patients with advanced heart failure carry substantial mortality, but this group has much to gain if they survive. Conventionally, the intra-aortic balloon pump (IABP) is used to assist weaning from cardiopulmonary bypass (CPB), but postischemic stunning may further impair myocardial function. This results in renal shutdown and deranged metabolic status. In established cardiogenic shock, attempted salvage with a left ventricular assist device (LVAD) carries a 50% to 75% mortality.1,2Go To improve outcome in borderline survival situations, we decided to wean directly from CPB to a short-term centrifugal blood pump.

Methods

The patients at highest risk are selected before surgery. Candidates may have left ventricular ejection fraction less than 20%, impaired renal function, or aortoiliac disease precluding IABP use. LVAD implantation is undertaken during 30 minutes of reperfusion, before discontinuation of CPB. Conduits for the inflow and outflow cannulas are used to improve the safety of decannulation (Figure 1).


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  		Figure 1. Tube of descending aortic homograft (8 cm length x 10 mm diameter) is sewn to incision at junction . . . [Full Text of this Article]

 





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