From April to December 1990, four patients were submitted to left ventricular assistance with centrifugal pump, because they presented cardiogenic shock after cardiac surgery, not responsive to intraortic balloon pump and drugs. The first patient had an aneurysm of anterior wall of the left ventricle with ejection fraction of 16% in the pre-operative period. The cardiac surgery was technically successful, but the patient could not be weaned from cardiopulmonary bypass with maximal pharmacological therapy and intra-aortic balloon pump. Then we used Biomedicus centrifugal pump for left ventricular assistance. The patient was assisted for 48 hours. Nowadays, she is in NYHA class II at eleventh post-operative month. The second case was a patient submitted to coronary bypass and mitral valve replacement. At second post-operative day the graft to LAD was occluded, resulting in cardiac arrest. The patient was put again in cardiopulmonary bypass, and could not be weaned. The left ventricle had a myocardial infarction, and the assisted circulation was used as a bridge to cardiac transplantation. After five days, without heart donor, he died due to a large embolus at lung. The third case was a patient with bad left ventricular function, submitted to coronary bypass. The patient could not be weaned of cardiopulmonary bypass. He was put in left assisted circulation for 32 hours. This patient had bleeding diathesis. He died in the fourth post-operative day due to respiratory failure. The fourth, case was a patient submitted to left ventricular aneurysm correction and coronary bypass. The patient could not be weaned of cardiopulmonary bypass and was put in left assisted circulation. He was assisted for 60 hours. The patient died in the 35th post-operative day due to respiratory failure. We believe that the more often utilization of various types of assisted circulation will lead to reduce global mortality of cardiac surgery. The intra-esophagic echocardiography in our four patients was useful in the evaluation of ventricular function.
assisted circulation; extracorporeal circulation