Tag Archives: circulatory support

Professor Stephen Westaby NICE’s medical therapy is excellent, until the end game, but drugs alone have limitations.5 Inotropes worsen ischaemia, while vasopressors elevate afterload. Injured myocardium needs rest to promote recovery, not a flogging.6 Consider two real patients. A 21-year-old female with ion-channelopathy is admitted to a tertiary care centre. After 75 DC shocks and cardiac massage she is in shock. She needs extracorporeal membrane oxygenation (ECMO) circulatory support but cannot be transferred.6 She dies. A 56-year-old male with ischaemic cardiomyopathy suffers acute on chronic heart failure. Renal impairment and pulmonar

Detailed preoperative work-up and careful patient selection with input from multi-disciplinary ‘heart teams’ (cardiac surgeons, interventional cardiologists, anaesthetists, nursing staff) are integral to good practice and to minimising the risk of what remains a complex and often challenging procedure. Serious complications (e.g. severe aortic regurgitation, major bleeding, device embolisation, coronary occlusion, and aortic dissection) are uncommon (<5%), but may precipitate sudden haemodynamic collapse necessitating cardiopulmonary bypass (CPB) or other mechanical support. Current guidelines, therefore, mandate ‘full haemodynamic c