Device in Patients With Cardiogenic Shock After Cardiac Operations

In spite of recent improvements in cardiac surgery, a small percentage of patients have severe postcardiotomy ventricular failure refractory to drugs and the intraaortic balloon. In our experience, the Pierce-Donachy external pneumatic ventricular assist device has proved to be one of the most effective devices for these patients. Since 1981,30 patients aged 15 to 71 years (mean age, 52 years) with profound cardiogenic shock refractory to conventional therapy after cardiotomy were supported with the Pierce-Donachy ventricular assist device. Fourteen required left ventricular support, 7 needed right ventricular support with an intraaortic balloon, and 9 had bivenuccessful application of mechanical circulatory supS port in patients with cardiogenic shock after cardiac operation was done in the mid-1960s by Spencer and associates [ 11 and DeBakey [2]. Recently, postcardiotomy circulatory support has been accomplished successfully in many patients with a variety of systems, including roller pumps [3], centrifugal pumps [4], and sac-type pneumatic pumps [5]. At St. Louis University, we have employed these devices for a variety of problems, but patients with profound cardiogenic shock after cardiotomy continue to present our greatest challenge. It is now apparent that our best results have been with the PierceDonachy ventricular assist device (VAD) designed by Pierce and Donachy at Pennsylvania State University [6]. This report analyzes our experience with the PierceDonachy VAD in postcardiotomy patients over the last 7 years, and attempts to establish guidelines for appropriate application of the device.