Factors influencing survival and successful weaning from clinical ventricular bypass with local heparinization and blood filtration: an analysis in 21 consecutive patients.

A simple circulatory support of transapical ventricular bypass type with nonpulsatile pumping and regional heparinization in 21 patients has revealed that several factors contribute to the patient's outcome. The duration of the bypass was not an essential determinant of prognosis and patients supported for 5--8 days could be weaned from TALVB. Those patients who could maintain steady hemodynamics with flow rates of 30--40% of cardiac output, were usually successfully weaned. Patients who required longer support with high flow rates (60--80% or over) had less probability of being weaned. Persistent or preexistent dysfunction of vital organs, as manifested by renal failure, brain damage, respiratory failure and infection, were main factors determining unsuccessful weaning. The complications related to pumping itself, thromboembolization, bleeding, infection and blood damage, were much less frequently observed with this type of support. The simplicity and less time consuming surgical technique for cannulation and, in addition, less harmful procedure of decannulation and avoidance of thrombus formation were directly related to the improved prognosis.