Maximizing survival potential in very high risk cardiac surgery.

The mean age and risk profile of patients referred for cardiac surgery is constantly increasing. Surgeons are now inclined to accept high-risk patients because interventional cardiology provides less invasive alternatives for an overlapping patient cohort. As risk profile increases so does hospital mortality. Patients who are difficult to wean from cardiopulmonary bypass and those who subsequently deteriorate into a low cardiac output state have mortality rates between 50% and 80%. In established cardiogenic shock, conventional treatment with inotropes, the intra-aortic balloon pump, or temporary circulatory support devices has not substantially improved survival. In the absence of the transplant option, more innovative circulatory support strategies are required to improve survival in the postcardiotomy setting.