Roy A. Jurado

Use of a Left Heart Assist Device after Intracardiac Surgery: Technique and Clinical Experience

A left heart assist device (LHAD) has been employed in 14 patients. All had advanced heart disease and were in low cardiac output after repair, such that they could not be separated from cardiopulmonary bypass despite prolonged support and adjuvant therapy, including drugs, pacing, and use of intraaortic balloon counterpulsation whenever possible. Apart from special cannulas, the equipment necessary for the LHAD is widely available. An asset of the system (left atrial-ascending aorta bypass of the left ventricle) is that it may be terminated without reentering the thorax to remove the cannulas. This is accomplished with precisely fitting obturators that obliterate the cannula lumens and allow the tubes to be permanently implanted. This concept is believed important since critically ill patients requiring support are precisely those in whom added risk would be imposed by a second operation. Of the 14 patients who have had intraoperative and postoperative support (up to 6.8 days), 9 were weaned from the device and 6 were dismissed from the hospital. Four patients remain alive and are improved, the longest at 22 months since operation. The favorable performance of the LHAD suggests that it may prove useful either when intraaortic balloon counterpulsation cannot be successfully deployed or when it has failed to achieve hemodynamic stability.

Thermal Skin Burns from a Carbon Dioxide Analyzer in Children

Abstract Following open-heart operation, five children sustained first-degree and second-degree burns on the forehead. The thermal trauma resulted from an expiratory carbon dioxide analyzer used in combination with the ventilator in the intensive care unit. A method to avoid this complication is described.

The Use of Vein Allografts as Sidearms for Intraaortic Balloon Insertion

Femoral artery cannulation for intraaortic balloon counterpulsation may be attended by difficulties due to changes in the vessel wall and the inherent stiffness of Dacron grafts. A substitute technique utilizing venous allografts is described. The advantages are enumerated and are related to allograft pliability. Fifty-nine such procedures have been done without related complications.

EXPERIENCE WITH A COMPUTER - ACTIVATED TREND - DETECTION ALARM FOR MEAN ARTERIAL AND LEFT ATRIAL PRESSURES

In our cardiac surgical intensive care unit (ICU) cardiopulmonary monitoring is accomplished with the aid of a central computer (IBM 1800) which routinely samples several parameters at ten minute intervals. For two of the monitored variables, namely mean arterial pressure (MAP) and left atrial pressure (LAP), we have programmed the computer to activate an alarm sequence.

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.

Early Clinical Experiences with a Heart Assist Device

A method of left heart (left atrium-aorta) support after open heart surgery is described. Thoracic reentry is not required when support is terminated. The system has been employed in 10 patients, 4 of whom are long-term survivors.