Mechanical Circulatory Support in Cardiovascular Surgical Patients: Single Center Practice and Experience

TL;DR

This study examines the use and outcomes of mechanical circulatory support devices in cardiovascular surgery patients at Fuwai Hospital.

Contribution

It provides a single-center analysis of the effectiveness and safety of IABP, ECMO, and VAD in managing severe cardiac insufficiency.

Findings

IABP had the highest survival rate (80.4%) compared to ECMO (54.9%) and LVAD (56.7%).

ECMO was associated with the highest rates of hemorrhage (35.9%) and acute kidney injury (29.6%).

The study confirms the effectiveness of these devices in managing hemodynamic instability in cardiovascular surgical patients.

Abstract

In view of the role of mechanical circulatory support in
patients with severe cardiac insufficiency during perioperative period, we
searched the relevant articles on mechanical circulatory support at Fuwai
Hospital, and analyzed the indications and complications of different mechanical
circulatory support methods.

Relevant studies were identified
by computerized searches of PubMed, Ovid, Embase, Cochrane Library, Wanfang Data,
VIP Data, Chinese BioMedical Literature & Retrieval System (SinoMed), and China
National Knowledge Infrastructure (CNKI), using search words (“intra-aortic
balloon counter pulsation” OR “IABP” OR “extracorporeal membrane
oxygenation” OR “ECMO” OR “ventricular assist device” OR “VAD”) AND
(“Fuwai” OR “fuwai”). All studies concerning the application of IABP, ECMO,
and VAD at Fuwai Hospital were included, exclusion criteria included: (1) studies
published as review, case report or abstract; (2) animal or cell studies; (3)
duplicate publications; (4) studies lacking information about outcomes of
interest.

A total of 36 literatures were selected for analysis.
The specific mechanical circulatory support methods of ECMO and VAD retrieved
from the studies were VA-ECMO and LVAD. The number of cases using IABP, ECMO,
LVAD was 1968, 972, 67; and the survival rate was 80.4%, 54.9%, 56.7%,
respectively. The major complications of IABP, ECMO and LVAD were hemorrhage
(1.2%, 35.9% and 14.5%), infection (3.7%, 12.7% and 9.7%), acute kidney
injury (9.1%, 29.6% and 6.5%), the secondary complications were limb ischemia,
neurological events, cardiovascular events and thrombosis.

The present study suggested that, IABP, ECMO and VAD, either alone or in
combination, were effective and safe mechanical circulation support when managing
cardiovascular surgical patients with severe hemodynamic instability at Fuwai
Hospital.

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