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The Role of Mechanical Devices

Devices to support the circulation and directly assist the ventricie during surgery are now both reliable and essential. The intraaortic balloon counterpuisation device is used in patients who fail to wean easily from cardiopulmonary bypass, who develop ischemia in the immediate postoperative period, or who have low output in the maximal edema phase, 4 to 8 hours postoperatively. Complications relate to the insertion of the device, which may cause major arterial disruption, lower leg ischemia, or distal arterial thromboemboii. Ventricular assist device (VAD) support is indicated when, despite the use of the intraaortic balloon, the patient's hemodynamics remain severely depressed and the patient is unable to wean from bypass. There are several contraindications to the use of VADs, inciuding pulmonary hemorrhage. Nevertheless, as experience with the many different types of VADs increases, their use may be extended to periods of days or even months. Various mechanical support devices have been used to bridge to cardiac transplantation, with ranging degrees of success. Decisions concerning the use of mechanical devices for this purpose must take into account both the standard contraindications to transplantation, and contraindications that develop or are acquired during intervention with the bridging device. Current and future experience will decide which devices will be accepted for common clinical use.