Management of postoperative biventricular failure by means of a right ventricular assist device and an intraaortic balloon pump.

Abstract

Right dominant biventricular failure often accompanies the end-stage of combined rheumatic valvular disease and some kinds of congenital heart disease. The management of right ventricular failure with conventional medical treatment, however, has encountered many difficulties. Mechanical support of the right ventricle with an RVAD (right ventricular assist device) has proved useful and effective. Seven patients who could not be weaned from cardiopulmonary bypass were subsequently transferred to an intraaortic balloon pump (IABP) and RVAD. Among these, five had severe combined rheumatic valvular disease, one had congenital heart disease and was advanced in age, and the other had a left atrial myxoma with tricuspid regurgitation. Preoperatively, all of these patients had had biventricular failure. All seven cases were successfully weaned from RVAD, and later from IABP. Five patients were discharged from the hospital and returned to normal daily life. Two patients died during their postoperative course. Long-term survival rate was 71%. Mechanical assist with RVAD and IABP seemed to be effective in the management of right dominant biventricular failure, such as that seen in combined valvular disease and some kinds of congenital heart disease.