Pharmacologic and mechanical methods of discontinuing extracorporeal circulation in patients with heart failure.
Separation from EC requires simultaneous optimal manipulation of heart rate and rhythm, loading conditions, afterload, and contractility. Patients with preexisting ventricular dysfunction will have alterations in beta-adrenergic receptors and responsiveness to catecholamines, but patients with previously normal ventricular function can also develop ventricular dysfunction. Catecholamines, by stimulating beta-adrenergic receptors, decrease systolic function to allow separation from EC. The phosphodiesterase inhibitors provide both inotropic support and vasodilation, to improve both systolic and diastolic function. When administered in combination, catecholamines and cyclic-AMP-specific phosphodiesterase inhibitors can have additive effects to restore beta 1-adrenergic responsiveness. Combination therapy provides an important support during biventricular dysfunction and facilitates separation from EC. Finally, mechanical support provides a therapeutic option when pharmacologic therapy is ineffective.
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