Assistances circulatoires post-opératoires

Abstract

Post cardiotomy circulatory support is mainly a bridge to recovery. French law indicate the necessity to have an available device, but the choice depends of experience and risk/benefit of transportation to a transplant center and bridge to bridge. Time to recovery is dependant of unloading, but results seem to be better after ECMO in case of pediatrics and cardiac transplant graft failure. ICU problems include frequent renal failure, multi-organ dysfunction related to SIRS, and hemorragic risk. Pulmonary hyertension is now easily controlled by inhaled NO. Nevertheless, global mortality is usualy higher (>60 %) than in bridge to transplant. Indication of post operative assistance should prevent these complications and need a rapid decision. In case of delay, biventricular assistance is required. New devices using axial non pulsatile flow are under trail in mitral surgery.