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(Circulation. 2007;116:586-587.)
© 2007 American Heart Association, Inc.

Editorial

Post–Cardiac Surgery Mechanical Support

A Tool for Decision Making

Daniel Marelli, MD; Richard J. Shemin, MD

From the Division of Cardiothoracic Surgery, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles.

Correspondence to Daniel Marelli, MD, Associate Professor, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte, 62-266 CHS, Los Angeles, CA 90095. E-mail dmarelli@mednet.ucla.edu

Key Words: Editorials • heart-assist device • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The report by Hernandez et al¹ in the present issue of Circulation is timely and important. Compiled from the Society of Thoracic Surgeons voluntary database, it comprises an analysis of the largest series of patients treated with mechanical support to date. The authors have reviewed outcomes of 5735 patients who had a ventricular assist device (VAD) placed for low cardiac output after having undergone a cardiac surgical procedure. Remarkably, this represents <0.5% of all cardiac operations. The authors observed significant improvement in outcome for these patients over a recent 10-year study period. Survival improved from 38.5% to 59.2%. Similarly, during the same time period, there was a reduction in major assist-device morbidity of bleeding, stroke, and renal failure. These results are in keeping with those from smaller, single-institution reports.^2–4

Article p 606

The authors attribute the improved results to advances in technology and more standardized postoperative care protocols. This has encouraged surgeons to implant assist devices earlier, before occurrence of irreversible end-organ damage.⁵ The most important determinant of poor outcome was whether the index procedure was being performed for salvage or reoperation. Preoperative need for dialysis was also an important predictor of mortality. These observations support those of others.⁶ Table 6 in the article by Hernandez et al¹ shows that the majority of patients who had VAD placement as a "bridge" to transplantation or as permanent lifetime therapy (destination) had left-sided support only, whereas those who were expected to recover had mostly right-sided support. Also, the authors noted that only . . . [Full Text of this Article]

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Issue Highlights
Circulation 2007 116: 585. [Extract] [Full Text]