Practice guidelines

908

Ann Thorae Surg

REPORT PRACTICE GUIDELINES

1994;58:903-10

Practice Guidelines Transplantation (heart, lung, heart-lung) and Heart Assist Devices: III Diagnosis:

Procedure:

Indication:

428

Heart failure

429.4

Cardiac insufficiency following cardiac surgery

997.1

Cardiac insufficiency during or resulting from a procedure

33975

Implantation of ventricular assist device; single ventricular support

33976

Implantation of ventricular assist device; biventricular support

33977

Removal of ventricular assist device; single ventricular support

33978

Removal of ventricular assist device; biventricular support

33999

Unlisted procedure, cardiac surgery

Unable to wean from cardiopulmonary bypass or maintain adequate circulation Deterioration in patient who is a candidate for cardiac transplantation-"bridge to transplant"

Confirmation of Indication: Contraindications:

Actions Prior to Procedure:

Actions During Procedure: Actions Following Procedure:

Outcome:

Lack of adequate response to appropriate volume loading, cardiac drugs, and intraaortic balloon pump 1)

Massive cardiac injury, unlikely to recover and patient not a transplant candidate

2)

Uncontrollable bleeding

3)

Severe irreversible vital organ injury, ie, liver, brain, or kidney

1)

Hemodynamic monitoring

2)

Administration of inotropic drugs

3)

Insertion of intraaortic balloon catheter

4)

Correction of blood volume deficit

5)

Correction of metabolic or blood gas abnormalities

Insertion of ventricular assist deviceis) with or without cardiopulmonary bypass 1)

Hemodynamic monitoring

2)

Management of assist devicets)

3)

Management of cardiac drugs

4)

Management of surgical wound, ie, reoperation for bleeding and tamponade

5)

Removal of assist devicets)

6)

Management of ventilation

7)

Management of chest tube drainage

8)

Consider if candidate for heart, heart-lung transplantation

1)

Hospital mortality 50%-80%

2)

Discharge 14-60 days

Ann Thorac Surg

1994;58:903-10

REPORT PRACTICE GUIDELINES

909

References 1. Pennington DC, Swartz MT. Assisted circulation and the mechanical heart. In: Braunwald E, ed. Heart disease. A textbook of cardiovascular medicine. 4th ed. Philadelphia: Saunders, 1992:535-50. 2. Proceedings of the 1991 Society of Thoracic Surgeons Circulatory Support Meeting. Ann Thorac Surg 1993;55:210-328.