Case report
Temporary assist device for postcardiotomy cardiac failure

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Abstract

Postcardiotomy left ventricular failure (LVF) complicating a cardiac surgical procedure is usually managed with intraaortic balloon pump (IABP) counterpulsation. We report two cases of postcardiotomy LVF unresponsive to inotropic support and IABP counterpulsation that were managed successfully with the use of the TandemHeart percutaneous ventricular assist device (pVAD) (CardiacAssist, Pittsburgh, PA). The TandemHeart pVAD appears to be safe and effective as a bridge to recovery in the treatment of postcardiotomy cardiac failure.

Section snippets

Patient 1

A 61-year-old man with unstable angina was admitted for redo coronary artery bypass grafting operation 10 years after a triple-vessel bypass grafting procedure. He had a history of claudication due to aortoiliac atherosclerotic disease. A preoperative angiogram revealed significant triple-vessel disease with blocked vein grafts to the circumflex and right coronary arteries and a 95% stenosis in a vein graft to the left anterior descending artery (LAD). On beating heart, without CPB (off-pump

Comment

Intraaortic balloon pumping was introduced more than 30 years ago and since then has been the most widely used means of providing mechanical support to a failing heart in a variety of settings. It has been preferentially used for postcardiotomy low-output syndrome, and it is considered to reduce mortality and morbidity in this setting [1]. When weaning from CPB is not possible despite inotropic and IABP support, a surgeon is left with no choice other than the use of ventricular assist devices

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