Ventricular Assistance: Clinical Experience at the Pennsylvania State University

Nearly 7% of cardiotomy patients cannot be weaned from cardiopulmonary bypass (CPB) following their open heart operation [1]. These patients demonstrate profound heart failure which, in most instances, will respond to conventional therapy, consisting of volume loading, inotropic support, and intra-aortic balloon (IAB) counterpulsation. One-quarter of all individuals with postcardiotomy cardiogenic shock, however, fail to respond to conventional therapy, and require a more effective form of temporary circulatory support [1, 2]. Paracorporeal ventricular assist devices provide such support by reducing pressure work during systole, thereby decreasing myocardial oxygen consumption. In addition, a left ventricular assist device (LVAD) can pump enough blood to maintain adequate systemic perfusion and coronary blood flow, thereby providing time for the metabolic recovery of injured myocardium. A right ventricular assist device (RVAD), used alone or in conjunction with an LVAD, serves to decompress the right heart, maintain flow through the pulmonary vasculature, and volume load the left ventricle.

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