Long-term survival with partial left heart bypass following perioperative myocardial infarction and shock.

Overview

During the period from July 1, 1978 to Dec. 31, 1980, we employed a partial left heart bypass (left atrium to ascending aorta) in 16 patients who could not be weaned from cardiopulmonary bypass with inotropic agents and the intra-aortic balloon pump. Flow rates up to 3,500 ml/min could be obtained with this device. Eight of the 16 patients survived and left the hospital. One patient died of a cardiac arrest 4 months postoperatively and one has recurrent angina and moderate congestive heart failure 24 months postoperatively. Six patients are well 5 to 17 months after discharge. Seven of the eight deaths were characterized by progressive myocardial failure. One patient died of ventricular fibrillation 18 hours after discontinuation of the left heart bypass. All survivors had significant improvement in ventricular function 12 to 24 hours afer institution of the left heart bypass, which was continued for 16 to 68 hours. These results indicate that early institution of left heart bypass in seriously ill patients can provide satisfactory long-term results.