Successful mechanical circulatory support for noncoronary shock

Academic Article

Abstract

  • Mechanically assisted recovery from shock and long-term survival of nontransplant patients with acute noncoronary myocardial decompensation have not been previously reported. We treated nine patients (aged 8 to 53 years) who were referred with acute nonischemic cardiogenic shock (pulmonary capillary wedge >20, cardiac index <1.5 L/min/m2, mean blood pressure <60 mm Hg, ejection fraction <0.3%). Eight patients had viral prodromes, and one patient was peripartum. All patients' lungs were mechanically ventilated, and pharmacologic support failed in all patients. Two patients received steroids. All received mechanical circulatory support. Seven were initially supported with intraaortic balloon counterpulsation pumps. Two patients recovered with intraaortic balloon counterpulsation pumps alone (3 days and 4 days). Four patients received left ventricular assist devices (3, 7, 10, and 79 days), and two received biventricular support devices (10 days and 14 days). One patient was supported with extracorporeal femoral vein-to-femoral artery bypass for 6 days. Four patients required dialysis (4 days to 5 weeks). Seven patients underwent myocardial biopsies, of which three demonstrated acute myocarditis. All patients recovered ventricular function (ejection fraction >0.55%), and all are New York Heart Association functional class I, 7 months to 4 1/2 years after support. Mechanical circulatory assist devices may be lifesaving for patients with acute nonischemic myocardial decompensation. Patients should be supported for at least 2 weeks before transplantation is considered.
  • Authors

    Author List

  • Dembitsky WP; Moore CH; Holman WL; Jaski BE; Moreno-Cabral RJ; Adamson RM; Daily PO; Moreno-Cabral CE
  • Start Page

  • 129
  • End Page

  • 135
  • Volume

  • 11
  • Issue

  • 1 I