Use of centrifugal pumps for postcardiotomy ventricular failure: Technique and anticoagulation

Background. Centrifugal pumps have been employed most commonly for postcardiotomy mechanical support after intraaortic balloon pumping has failed. Despite their effectiveness in some patients, morbidity remains high. Methods. Our clinical experiences with centrifugal pumps were reviewed with particular attention to common morbidity such as bleeding, coagulopathy, and thromboembolism. Evolution of cannulation techniques and anticoagulation strategies were defined. Morbidity during early and more recent experience was compared. Results. Deranged coagulation and excessive mediastinal bleeding were commonly observed in patients undergoing centrifugal mechanical assist for postcardiotomy cardiogenic shock. Evolved strategies to reduce blood loss included meticulous cannulation techniques, early use of blood components, and an aggressive policy of mediastinal reexploration. Thromboembolism occurred with centrifugal mechanical assist, was underestimated by clinical events, and dictated pursuit of improved anticoagulation strategies and device refinement. A clinically significant trend of decreasing morbidity from early to recent experience was observed. Conclusions. Increasing clinical experience with centrifugal mechanical assist appears to result in a clinically relevant decrease in morbidity.