Postcardiotomy right ventricular failure: experience with pulmonary arterial balloon counterpulsation and pulmonary arterial venting.

From 1981 through 1985, 3,057 patients underwent cardiac operations using cardiopulmonary bypass (CPB) at our institution. When we reviewed these cases, we found that in ten cases (0.32%) right ventricular or biventricular failure had prevented weaning from CPB. All ten patients were also refractory to pharmacologic intervention and to systemic intraaortic balloon pumping. Two patients had isolated right ventricular failure, and the other eight had biventricular failure. Four patients had had previous pulmonary hypertension. Of the ten patients who could not be weaned, three were treated with pulmonary arterial balloon counterpulsation (PABC), and seven underwent pulmonary arterial venting (PAV). Procedures performed concomitantly with PABC included left heart bypass in one case and creation of an atrial septal defect in another case. All of the PAV group underwent concomitant intraaortic balloon pumping. One PABC patient and four PAV patients could be weaned from CPB. All who were treated with PABC eventually died, but there are three long-term survivors in the PAV group. In light of this study, biventricular unloading with PAV appears to be a valid method of treating right ventricular or biventricular failure.