RT Book, Section
A1 McGee, Edwin C.
A1 Moazami, Nader
A2 Cohn, Lawrence H.
SR Print(0)
ID 55916135
T1 Chapter 18. Temporary Mechanical Circulatory Support
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesssurgery.mhmedical.com/content.aspx?aid=55916135
RD 2024/04/20
AB A  number  of  ventricular  assist  devices  (VADs)  are  available  for  acute  circulatory  support.  As  opposed  to  long-term  VADs,  which  are  designed  for  bridge  to  transplantation  or  long-term  support  in  the  nontransplant  patient,  temporary  VADs  are  designed  to  reestablish  adequate  organ  perfusion  rapidly.  Patients  in  cardiogenic  shock  require  early  aggressive  therapy.  Despite  relief  of  ischemia,  inotropic  drugs,  and  control  of  cardiac  rhythm,  some  patients  remain  hemodynamically  unstable  and  require  some  type  of  mechanical  circulatory  support  in  order  to  restore  a  normal  cardiac  output.  Cardiogenic  shock  occurs  in  2.4  to  12%  of  patients  with  acute  myocardial  infarction  (AMI).1  The  Should  We  Emergently  Revascularize  Occluded  Coronaries  for  Cardiogenic  Shock  (SHOCK)  trial  demonstrated  mortality  of  greater  than  50%  despite  revascularization.2  If  instituted  promptly,  temporary  mechanical  support  potentially  leads  to  improved  survival  in  this  group  of  patients.3  The  need  for  circulatory  support  in  the  postcardiotomy  period  is  relatively  low  and  has  been  estimated  to  be  in  the  range  of  0.2  to  0.6%,4  but  when  it  occurs,  it  needs  to  be  managed  effectively  if  the  patient  is  to  be  salvaged.  Additional  indications  for  acute  VADs  are  in  chronic  heart  failure  patients  who  suffer  cardiovascular  collapse,  and  severe  cases  of  myocarditis  and  postpartum  cardiomyopathy.