The Annals of thoracic surgery
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Right-sided circulatory failure remains a significant source of morbidity and mortality for both cardiac transplant and left ventricular assist device recipients. ⋯ Right ventricular assist devices work most effectively if implanted early enough to avoid significant, potentially irreversible end-organ injury. We liberally employ continuous arteriovenous hemodialysis, minimize the use of heparin immediately postoperatively, keep patients sedated, and continue RVAD support until the patient displays signs of hemodynamic and end-organ recovery as heralded by (1) a decrease in central venous pressure and, more importantly, a decrease in pulmonary artery diastolic pressure, (2) an increase in urine output, and (3) a decrease in serum transaminase levels.
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The data presented are a brief summary of The International Registry for Mechanical Ventricular Assist Pumps and Artificial Hearts and a summary of the personal experience of the Minnesota Thoracic Associates at the Minneapolis Heart Institute with the use of the Sams centrifugal pump from May 1985 to September 1994. ⋯ It is our belief that when considering the cost analysis of temporary devices, one must conclude that a more economical approach for the treatment of end-stage cardiac disease would be aggressive development of a permanent ventricular assist device.
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Two types of ventricular assist systems have been approved for use by the Japanese government. ⋯ From these data, the Toyobo pump and the Zeon pump are useful for short-term support for acute, profound heart failure. The Toyobo pump also may provide sufficient support as a bridge to transplantation for the medium term.
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Bio-Medicus centrifugal ventricular support has been used widely for postcardiotomy cardiac failure. The purpose of this study was to review a large series of support patients examining complications and outcomes. ⋯ Bio-Medicus centrifugal ventricular support can be implemented rapidly and relatively easily. There are few device-related complications and the cost is relatively inexpensive compared with other assist systems. This series demonstrates that a substantial number of patients who experience reversible postcardiotomy myocardial injury will benefit from temporary centrifugal ventricular support.
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In spite of modern cardiac surgical techniques, severe cardiogenic shock not responding to pharmacologic therapy and intraaortic balloon pumping develops in about 0.2% to 1.2% of patients undergoing cardiac operations. ⋯ The results justify the use of Thoratec assist device in patients with severe preoperative cardiogenic shock.