Factors for successful weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with low cardiac output syndrome after cardiovascular surgery.

The objective of this study was to analyze the early predictive factors for successful weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with low cardiac output syndrome after cardiovascular surgery. A total of 938 patients underwent cardiovascular surgery with cardiopulmonary bypass (CPB) from January 1991 to September 2006 at Gunma University Hospital. Of these 938 patients, 13 (1.4%) required PCPS to maintain hemodynamics within 48 hours after surgery. The mean age of the 13 patients was 66 years (range, 45 to 86 years). Nine patients underwent open-heart surgery, 3 repair of a thoracic aortic aneurysm, and 1 a pericardiectomy. The patients were divided into 2 groups; group A (n = 4) who were removed from PCPS and group B (n = 9) who were not removed from PCPS. The conditions during the operation and after PCPS support were compared between the 2 groups. The mean age was higher, and operation time, CPB time, and aortic cross-clamping time were significantly (P < 0.05) longer in patients with PCPS than in those without PCPS. The mean PCPS time in all 13 patients was 190 +/- 122 hours. The mean age was higher, and CPB time and the aortic cross-clamping time were longer in group B than in group A (NS). The mean duration of PCPS support was significantly (P < 0.05) shorter in group A than in group B (117 +/- 42 hours versus 235 +/- 136 hours). PCPS flow in group A could be reduced from 48 hours after PCPS induction. However, PCPC flow in group B could not be reduced, and there were significant (P < 0.05) differences in PCPS flow at 72 and 96 hours after starting PCPS. Significant (P < 0.05) differences in the absolute values of the APACHE II score, serum lactate levels, administered epinephrine dose, and levels of total bilirubin (T-Bil), serum creatinine (sCr), and lactate dehydrogenase (LDH) were found between the 2 groups within 96 hours after PCPS induction. In addition, there were significant (P < 0.05) differences in the rate of change compared with the baseline control value obtained prior to PCPS use in PCPS flow, APACHE II score, and levels of T-Bil, sCr, and LDH within 96 hours after PCPS induction. Significant differences in the rate of change of sCr and LDH were found, especially from the early phase after PCPS use, compared with other parameters. In the patients removed from PCPS, PCPS flow could be reduced within 48 hours after commencement of PCPS. Improvements in the APACHE II score and biochemical variables within 96 hours appear to be reliable prognostic factors for PCPS patients.

[1]  A. Hoskote,et al.  Extracorporeal life support after staged palliation of a functional single ventricle: subsequent morbidity and survival. , 2006, The Journal of thoracic and cardiovascular surgery.

[2]  G. Sarris,et al.  Extracorporeal membrane oxygenation circulatory support after cardiac surgery. , 2004, Transplantation proceedings.

[3]  T. Spray,et al.  Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation* , 2004, Critical care medicine.

[4]  S. Bratton,et al.  Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. , 2003, The Annals of thoracic surgery.

[5]  Y. Nagayoshi,et al.  Clinical effects of percutaneous cardiopulmonary support in severe heart failure: early results and analysis of complications. , 2003, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[6]  W. Ko,et al.  Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. , 2002, The Annals of thoracic surgery.

[7]  T. Doyle,et al.  Modified Norwood operation for hypoplastic left heart syndrome. , 2001, The Annals of thoracic surgery.

[8]  S. Chu,et al.  Preliminary result of an algorithm to select proper ventricular assist devices for high-risk patients with extracorporeal membrane oxygenation support. , 2001, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[9]  W. Norwood,et al.  Is there a role for extracorporeal life support after stage I Norwood? , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[10]  N. Smedira,et al.  Postcardiotomy mechanical support: risk factors and outcomes. , 2001, The Annals of thoracic surgery.

[11]  C. E. Miller,et al.  Extracorporeal membrane oxygenation for infant postcardiotomy support: significance of shunt management. , 2000, The Annals of thoracic surgery.

[12]  S. Bolling,et al.  Extracorporeal life support to left ventricular assist device bridge to heart transplant: A strategy to optimize survival and resource utilization. , 1999, Circulation.

[13]  Y. Morishita,et al.  Factors for weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with severe cardiac failure: a comparative study in weaned and nonweaned patients. , 2006, International heart journal.

[14]  Y. Morishita,et al.  Prolonged use for at least 10 days of intraaortic balloon pumping (IABP) for heart failure. , 2005, International heart journal.

[15]  O. Kemmotsu,et al.  Therapeutic strategy of perioperative use of percutaneous cardiopulmonary bypass support (PCPS) for adult cardiac surgery. , 1999, The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi.