Simple alternatives using a single centrifugal pump for biventricular assistance in cardiogenic shock.

The application of pumps and other mechanical and physiologic aids for improving circulation and heart recovery must be based on physiologic requirements. The needs of circulation and cardiac recovery are different and depend on competence of the right ventricle as well as the left ventricle and the pattern of cannulation and decompression. Our studies of various bypass techniques and drugs in a standardized severe cardiogenic shock model lead us to believe that biventricular decompression can be accomplished with a single centrifugal pump without an oxygenator. Cardiogenic shock and severe biventricular failure was best treated by LV + RA bypass, based on survival, hemodynamics and metabolism. LA + RA bypass was the next best. LA bypass, LV bypass, substrates (cysteine and ribose) and nitroprusside were intermediate. Circulatory support is not enough unless appropriate cardiac decompression ensures myocardial recovery.