655 A New Bowel Management Strategy Reduces Gastrointestinal Complications and Improves Patient Outcomes after Ventricular Assist Device Implantation

Purpose: Post-cardiotomy cardiogenic shock carries a substantial morbidity and mortality. Short term ventricular assist devices (VADs) are frequently used in patients with cardiogenic shock refractory to conventional therapy. Here we report the outcome of our experience. Methods and Materials: Retrospective analysis was performed for patients who received either left, right, or bi-ventricular assist device for postcardiotomy shock between 1/2001 to 5/2010. Results: During the study period, 37 patients required short term VAD (11 LVADs, 9 RVADs, and 17 BIVADs) support. 18 patients received Centrimag, 8 received Abiomed BVS, and 11 received other devices. Initial cardiac surgery were CABG (15 patients), CABG/Valve (15 patients), Valve (4 patients) and other procedures (3 patients). The overall one-year-survival was 25.4% by Kaplan-Meier survival function. VAD specific 1-year survival was 36.4% for LVAD, 33.3% for RVAD, 10.1% for BIVAD, and was not significantly different by log-rank test (p 0.69). Median interval to device implantation was 3 days (range 0 25 days). Patients that underwent VAD implantation on postoperative day 2 to 6 had better survival (6 of 15 survived) than those who underwent implantation within the first day (2 of 11 survived) or 7 days following the initial cardiotomy (1 of 11 survived). There was no improvement of survival over the study period from 2001 to 2010. Conclusions: The outcome of VAD support for postcardiotomy shock remains poor. Requirement of VAD support in early postoperative period, but not immediately after the cardiotomy, seems to be associated with better overall survival. 655