2000 JACC Vol. In the intermediate or long-term group are those who are suitable for transplantation but deteriorate before a heart becomes available and require mechanical support prior to transplantation. A small percentage of these patients with chronic HF regain ventricular function and are able to have the devices removed without requiring transplantation. The third group of patients has irreversible cardiac failure that might require circulatory support, but they are not good candidates for cardiac transplantation. Post-cardiotomy patients may require support for a variety of problems, often relating to the sequelae of perioperative MI, valve disease or problems of myocardial preservation.
Several devices are available to support post-cardiotomy shock patients.
The systems have been improved recently by heparin coating of the circuits, which may reduce the incidence of thromboembolism as well as the bleeding caused by anticoagulation. However, these systems do not always provide adequate LV decompression, a primary determinant of recovery. Four centrifugal pumps are currently available and provide the advantage of biventricular support, but they also present problems of anticoagulation. The Thoratec VAD allows for ambulation and management out of an ICU setting. A small group of patients in the post-cardiotomy group undergo support for a period of time without recovery of cardiac function and become candidates for cardiac transplantation.