Left heart assist device: early clinical experiences with management of postperfusion low cardiac output.

Low cardiac output is a continuing cause of mortality after intracardiac operation in patients coming to surgery with advanced myocardial dysfunction. A simple method using a left heart assist device (LHAD) after open heart surgery to manage low cardiac output resistant to all adjuvant therapy is described. Except for the special cannulas, all equipment necessary for the LHAD is available in any unit performing open-heart surgery. Fifteen patients who could not be separated from conventional cardiopulmonary bypass underwent postoperative support with the LHAD (up to 501 hours). Ten patients were weaned from the device and 6 were dismissed from the hospital. Four patients remain alive, the longest period after operation being 24 months. A major asset of the LHAD is that thoracic reentry is not required at termination of LHAD support, since their design permits the cannulas to remain permanently in situ. This is thought to be an important concept, since critically ill patients requiring support are precisely those in whom added risk would be imposed by a second operation.