Usefulness of postoperative percutaneous cardiopulmonary support using a centrifugal pump: retrospective analysis of complications

Between January 1992 and December 1997, we employed percutaneous cardiopulmonary support (PCPS) using a centrifugal pump in 25 patients. In 21 of them, PCPS was used postcardiotomy. These patients could not be weaned from cardiopulmonary bypass due to profound ventricular failure. As for the other 4 patients, PCPS was used preoperatively for profound cardiogenic shock, a thrombosed valve, a stuck valve, and pulmonary embolization. Nine patients (43%) were weaned from PCPS (Group 1), and 3 (14%) were discharged from the hospital. The other 12 patients (57%) had perioperative extensive myocardial infarction and could not be weaned (Group 2). The causes of death were bleeding and multiple organ failure (MOF) associated with ventricular failure. The reasons for MOF were perioperative massive transfusion and hepatic congestion caused by sustained ventricular failure. To increase the survival rate, complete hemostasis and prevention of increased central venous pressure by early use of PCPS are necessary.     

Strategy of circulatory support with percutaneous cardiopulmonary support

We evaluated the efficacy and problems of circulatory support with percutaneous cardiopulmonary support (PCPS) for severe cardiogenic shock and discussed our strategy of mechanical circulatory assist for severe cardiopulmonary failure. We also described the effects of an alternative way of PCPS as venoarterial (VA) bypass from the right atrium (RA) to the ascending aorta (Ao), which was used recently in 3 patients. Over the past 9 years, 30 patients (20 men and 10 women; mean age: 61 years) received perioperative PCPS at our institution. Indications of PCPS were cardiopulmonary bypass weaning in 13 patients, postoperative low output syndrome (LOS) in 14 patients, and preoperative cardiogenic shock in 3 patients. Approaches of the PCPS system were the femoral artery to the femoral vein (F-F) in 21 patients, the RA to the femoral artery (RA-FA) in 5 patients, the RA to the Ao (RA-Ao) in 3 patients, and the right and left atrium to the Ao in 1 patient. Seventeen (56.7%) patients were weaned from mechanical circulatory support (Group 1) and the remaining 13 patients were not (Group 2). In Group 1, PCPS running time was 33.1 +/- 13.6 h, which was significantly shorter than that of Group 2 (70.6 +/- 44.4 h). Left ventricular ejection fraction was improved from 34.8 +/- 12.0% at the pump to 42.5 +/- 4.6% after 24 h support in Group 1, which was significantly better than that of Group 2 (21.6 +/- 3.5%). In particular, it was 48.6 +/- 5.7% in the patients with RA-Ao, which was further improved. Two of 3 patients with RA-Ao were discharged. Thrombectomy was carried out for ischemic complication of the lower extremity in 5 patients with F-F and 1 patient with RA-FA. One patient with F-F needed amputation of the leg due to necrosis. Thirteen patients (43.3%) were discharged. Hospital mortality indicated 17 patients (56.7%). Fifteen patients died with multiple organ failure. In conclusion, our alternate strategy of assisted circulation for severe cardiac failure is as follows. In patients with postcardiotomy cardiogenic shock or LOS, PCPS should be applied first under intraaortic balloon pumping (IABP) assist for a maximum of 2 or 3 days. In older aged patients particularly, the RA-Ao approach of PCPS is superior to control flow rate easily, with less of the left ventricular afterload and ischemic complications of the lower extremity. If native cardiac function does not recover and longer support is necessary, several types of ventricular assist devices should be introduced, according to end-organ function and the expected support period.     

Hemolysis in Different Centrifugal Pumps

Abstract: Different types of centrifugal pumps cause different amounts of hemolysis based on shear stress and blood exposure time. However, the hemolytic characteristics of centrifugal pumps in each clinical condition are not always clear. We compared the hemolytic characteristics of one cone-type centrifugal pump (Medtronic Bio-Medicus BP-80) and 2 impeller-type centrifugal pumps (Nikkiso HMS-12 and Terumo Capiox) under experimental conditions simulating their use in cardiopulmonary bypass (CPB), extracorporeal membrane oxygenation (ECMO), and percutaneous cardiopulmonary support (PCPS) as well as their use as left ventricular assist devices (LVADs). The normalized indexes of hemolysis (NIHs; grams free plasma hemoglobin per 100 L blood pumped) during use as LVADs were not significantly different among the 3 pumps. The BP-80 pump produced almost 3–fold more hemolysis than the HMS-12 and Capiox pumps during CPB, 3– to 4–fold more hemolysis during ECMO, and 5.5–fold more hemolysis during PCPS. The 2 impeller-type centrifugal pumps will therefore cause less hemolysis under high flow, high pressure difference (as in CPB) and low flow, high pressure difference (as in ECMO and PCPS) conditions than the cone-type pump.     

Clinical experience of a percutaneous ventricular support for profound heart failure following acute myocardial infarction--a case report]

Percutaneous biventricular support with centrifugal pump was applied to a 59-year-old man with profound heart failure following acute myocardial infarction. Direct coronary angioplasty was performed under percutaneous cardiopulmonary support (PCPS). After angioplasty, he could not be weaned from PCPS under IABP. We used percutaneous left ventricular support (PLVS) with transseptal left atrial cannulation. PLVS could not maintain effective assist flow and he developed a cardiogenic shock again. PCPS was added to PLVS, and percutaneous biventricular support was started. Assist flow ranged 1.7-3.0 L/min in PLVS, and 1.7-2.0 L/min in PCPS, and total assist flow was 3.4 L/min. Pulsatile pressure was obtained by adding IABP. The patient was successfully weaned from PCPS in 26 hours and PLVS in 118 hours. Patient is alive and well one year after PLVS. Combination of PLVS and PCPS is an effective ventricular support system, being less invasive than conventional method with thoracotomy, and may be useful for profound heart failure.     

Percutaneous cardiopulmonary support with heparin-coated circuits in postcardiotomy cardiogenic shock. Efficacy and comparison with left heart bypass.

OBJECTIVE: Percutaneous cardiopulmonary support, a simplified form of venoarterial bypass, using totally heparin-coated circuits, has recently come into clinical use. To clarify its efficacy in postcardiotomy cardiogenic shock to aid weaning from cardiopulmonary bypass, we compared results of percutaneous cardiopulmonary support with those of left heart bypass using a centrifugal pump. METHODS: We reviewed 18 patients treated between 1991 and 1998 who could not be weaned from cardiopulmonary bypass. Nine were aided by totally heparin-coated percutaneous cardiopulmonary support (PCPS group), and 9 supported by left heart bypass using a centrifugal pump (LHB group). In both groups, activated clotting time was controlled at 150-200 seconds using minimal doses of heparin as needed. RESULTS: Weaning and survival rates were higher in the PCPS group than in the LHB group (100% vs 55.6%, and 66.7% vs 22.2%). The PCPS group had a smaller amount of blood loss and needed a smaller amount of blood components in the immediate postoperative period. One percutaneous cardiopulmonary support patient required surgical re-exploration for postoperative bleeding (11.1%), but no clinical thromboembolic event occurred in the PCPS group. In the LHB group, 5 patients underwent surgical re-exploration for postoperative bleeding (55.6%), and 2 underwent thrombus extirpation in the left ventricle (22.2%). CONCLUSIONS: Although this study was retrospective and historical backgrounds could have been involved, our data suggest that totally heparin-coated percutaneous cardiopulmonary support system appears more effective as an aid to weaning from cardiopulmonary bypass and in short-term circulatory support for patients in postcardiotomy cardiogenic shock.     

Plasma brain natriuretic peptide reflects left ventricular function during percutaneous cardiopulmonary support

BACKGROUND: Plasma levels of brain natriuretic peptide (BNP), a cardiac hormone secreted predominantly from the ventricle, are elevated in patients with myocardial infarction, hypertension, and dilated cardiomyopathy. In this study, we assessed the usefulness of measuring BNP to evaluate left ventricular function in patients with severe heart failure receiving mechanical circulatory support. METHODS: Plasma BNP and creatine kinase (CK)-MB levels were measured serially in 8 consecutive patients with cardiogenic shock who received percutaneous cardiopulmonary support (PCPS) at Osaka Police Hospital from August 1999 to March 2000. Coronary artery bypass grafting or percutaneous transluminal coronary angioplasty was also performed in 5 patients during PCPS; in addition, 1 patient underwent insertion of a left ventricular venting catheter and implantation of a left ventricular assist system after PCPS. RESULTS: Five patients were weaned from PCPS, and 3 died. In survivors, plasma BNP and CK-MB levels correlated positively and significantly (r = 0.968, p = 0.03). After PCPS was initiated, plasma BNP levels gradually decreased in survivors, but not in patients who died (p = 0.003). CONCLUSIONS: These results suggest that plasma BNP levels accurately reflect myocardial damage in patients undergoing PCPS. A decrease in BNP might appear to indicate improved left ventricular function and predict successful weaning from mechanical support.     

Experiences of Postcardiotomy Assist: Pneumatic Ventricular Assist Device or Venoarterial Bypass with Percutaneous Cardiopulmonary Support

Abstract: From October 1982 to the present, 16 patients have been supported by a pneumatic ventricular assist device (VAD). Since April 1990, we have introduced a venoarterial bypass (VAB) with percutaneous cardiopulmonary support (PCPS) system. This PCPS system was used in 12 patients. The long-term survival rate of PCPS cases (41%) was much better than that of VAD cases (19%). The main cause of death in VAD cases was multiple organ failure (MOF). Although VAB was initiated more recently than VAD, the duration on support was longer in the VAD group than in the VAB group. Because of the longer support duration and the presence of many patients with MOF, coagulopathy deteriorated more readily in the VAD group than in the VAB group. In the case of postcardiotomy cardiopulmonary bypass weaning or low-output syndrome (LOS), the VAB with PCPS system should be applied first under intraaortic balloon pumping assist because of its simplicity and low cost. Thereafter, VAD should be applied in cases refractory to VAB support.     

Pulsatile mechanical cardiac assistance in pediatric patients with the Berlin heart ventricular assist device

Mechanical cardiac assistance for neonates, infants, children and adolescents may be accomplished with pulsatile ventricular assist devices (VAD) instead of extracorporeal membrane oxygenation or centrifugal pumps. The Berlin Heart VAD consists of extracorporeal, pneumatically driven blood pumps for pulsatile univentricular or biventricular assistance for patients of all age groups. The blood pumps are heparin-coated. The stationary driving unit (IKUS) has the required enhanced compressor performance for pediatric pump sizes. The Berlin Heart VAD was used in a total number of 424 patients from 1987 to November 2001 at our institution. In 45 pediatric patients aged 2 days-17 years the Berlin Heart VAD was applied for long-term support (1-111 days, mean 20 days). There were three patient groups: Group I: "Bridge to transplantation" with various forms of cardiomyopathy (N = 21) or chronic stages of congenital heart disease (N = 9); Group II: "Rescue" in intractable heart failure after corrective surgery for congenital disease (N = 7) or in early graft failure after heart transplantation (N = 1); and Group III: "Acute myocarditis" (N = 7) as either bridge to transplantation or bridge to recovery. Seventeen patients were transplanted after support periods of between 4 and 111 days with 12 long-term survivors, having now survived for up to 10 years. Five patients (Groups I and III) were weaned from the system with four long-term survivors. In Group II only one patient survived after successful transplantation. Prolonged circulatory support with the Berlin Heart VAD is an effective method for bridging until cardiac recovery or transplantation in the pediatric age group. Extubation, mobilization, and enteral nutrition are possible. For long-term use, the Berlin Heart VAD offers advantages over centrifugal pumps and ECMO in respect to patient mobility and safety.     

A Newly Developed Silicone-Coated Membrane Oxygenator for Long-Term Cardiopulmonary Bypass and Cardiac Support

Abstract: The surface of polypropylene hollow fiber was successfully coated with a very thin (0.2 μm) silicone layer. Experimental studies were performed in long-term (6 h) normothermic cardiopulmonary bypass (CPB) using 10 goats. A conventional membrane oxygenator (Mera Exce-lung HPO-lSH, MERA, Tokyo, Japan) was used for 5 goats as a control (Group C) and a new silicone-coated membrane oxygenator, which is of the same construction as that of the one used for Group C, for 5 (Group S). The O₂transfer and CO₂removal functions showed the same ranges. In the other parameters, there were no differences between the 2 groups. As for hemolysis, however, the plasma free hemoglobin of Group S was lower than that of Group C. Currently, 3 chronic percutaneous cardiopulmonary support (PCPS) experimental models have been conducted, and there has been no evidence of thromboembo-lism or deterioration of the oxygenator. In conclusion, this new oxygenator is suitable not only for CPB, but also for long-term cardiac support.     

An emergency aortic valve replacement for cardiogenic shock patient with severe aortic stenosis and regurgitaiton using percutaneous cardiopulmonary support

The percutaneous cardiopulmonary support system (PCPS) was used in a 64-year-old woman with cardiogenic shock due to sustained ventricular fibrillation (Vf) caused by severe aortic stenosis and regurgitation. The Vf attack was resistant to cardioversion and adrenaline for lack of left ventricular support by PCPS. She was transported to the operation theater with PCPS in situ and emergency aortic valve replacement was performed. Although preoperative cardiac resuscitation time was long (35 minutes), she was discharged from the hospital on foot without any neurological complications on 84th postoperative day. Because PCPS does not decrease left ventricular systolic stress in poorly contracting dilated heart, early surgical treatment is needed in patients with severely damaged heart.     

Successful resuscitation of intractable hyperkalemic cardiac arrest

We report on a 42-year-old oliguric uremic man on regular hemodialysis who developed sudden cardiac arrest, secondary to severe hyperkalemia, with a plasma potassium concentration of 9.7 mEq x l(-1). The cardiac arrest persisted after the initiation of cardiopulmonary resuscitation and intensive treatment for marked hyperkalemia for an hour and 55 minutes. Therefore a portable percutaneous cardiopulmonary support (PCPS) system had to be instituted while the patient had very prolonged refractory ventricular fibrillation. His cardiac rhythm was restored immediately after application of PCPS and he recovered without neurological sequelae. We therefore suggest that PCPS should be considered as a therapeutic option during cardiopulmonary resuscitation for life-threatening cardiac arrest secondary to severe hyperkalemia.     

Experience with the Sarns centrifugal pump in postcardiotomy ventricular failure.

The reported clinical use of the Sarns centrifugal pump (Sarns, Inc./3M, Ann Arbor, Mich.) as a cardiac assist device for postcardiotomy ventricular failure is limited. During a 25-month period ending November 1988, we used 40 Sarns centrifugal pumps as univentricular or biventricular cardiac assist devices in 27 patients who could not be weaned from cardiopulmonary bypass despite maximal pharmacologic and intraaortic balloon support. Eighteen men and nine women with a mean age of 60.4 years (28 to 83) required assistance. Left ventricular assist alone was used in 12 patients, right ventricular assist in 2, and biventricular assist in 13. The duration of assist ranged from 2 to 434 hours (median 45). Centrifugal assist was successful in weaning 100% of the patients. Ten of 27 patients (37%) improved hemodynamically, allowing removal of the device(s), and 5 of 27 (18.5%) survived hospitalization. Survival of patients requiring left ventricular assist only was 33.3% (4/12). Complications were common and included renal failure, hemorrhage, coagulopathy, ventricular arrhythmias, sepsis, cerebrovascular accident, and wound infection. During 3560 centrifugal pump hours, no pump thrombosis was observed. The Sarns centrifugal pump is an effective assist device when used to salvage patients who otherwise cannot be weaned from cardiopulmonary bypass. Statistical analysis of preoperative patient characteristics, operative risk factors, and postoperative complications failed to predict which patients would be weaned from cardiac assist or which would survive.     

Long-term application of percutaneous cardiopulmonary support system without systemic heparinization

Though the amount of systemic heparin sodium administration was reduced after the introduction of heparin sodium-coating material to percutaneous cardiopulmonary support system (PCPS), bleeding due to heparin sodium is still the one of the major complications. In 2 patients of postcardiotomy cardiogenic shock, we neutralized heparin sodium by protamine sulfate administration immediately after the institution of PCPS and did not perform systemic heparinization until hemostasis was secured. The time on PCPS without heparin sodium was 37 hours in 1 patient and 91 hours in another patient. While systemic heparin sodium was not administered, activated clotting time (ACT) ranged from 109 to 148 sec and the bypass flow rate was maintained in more than 2.5 l/min. The exchange of the devices was unnecessary during the assistance and the patients were successfully weaned from PCPS without major complications. We conclude that systemic anticoagulation can be avoided in the case of life-threatening hemorrhage.     

Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps?

BACKGROUND: Early implantation of centrifugal devices in patients with postcardiotomy cardiogenic shock may provide a bridge to recovery and allow subsequent long-term survival. METHODS: Since January 1989, 62 patients were supported with centrifugal pumps because of failure to wean from cardiopulmonary bypass. Indications were postcardiotomy cardiogenic shock (PCCS) (n = 60), bridge to cardiac retransplantation (n = 1), and right ventricular failure (n = 1). Patients' ages ranged from 23 to 78 years; 40 were men (65%), and 22 were women (35%). Twenty-two patients (35%) had a left ventricular assist device; 9 patients (15%) had a right ventricular assist device; and 31 patients (50%) had a biventricular assist device. Length of support ranged from 1 day to 19 days. RESULTS: Forty-two patients (68%) were weaned successfully; 27 patients survived to discharge (44%). Complications included bleeding (n = 41, 66%), renal failure (n = 28, 45%), and respiratory failure (n = 26, 42%). Currently, 23 patients survived 10 or more years (n = 1), 6 to 10 years (n = 7), 1 to 5 years (n = 10), and less than 1 year (n = 5). CONCLUSIONS: Centrifugal pumps are available, easy to use, and relatively inexpensive. Our experience justifies their continued use as a bridge to recovery for patients with postcardiotomy cardiogenic shock, despite the availability and increasing use of more expensive devices.     

Clinical Experience of Assisted Circulation with a Centrifugal Pump at Tokyo Women's Medical College

Abstract: In postpericardiotomy patients, the use of pulsatile pumps is limited in a semielective fashion to patients whose postoperative marginal hemodynamics are expected preoperatively. Since 1989, 25 patients have under-gone assisted circulation with a centrifugal pump: 15 (60%) were weaned from the pump, and 7 (28%) survived. In 1988, we heparin-coated the Bio-Pump using the Carmeda technique and developed a totally heparin-coated left heart bypass system together with heparin-coated cannulas and tubing. Four postpericardiotomy patients underwent left heart bypass with this system without heparin for 2 to 9 days. No thrombus was detected in the system. Left heart bypass with a centrifugal pump has been used as a supportive method in surgical repair of thoracic or thoracoabdominal aortic aneurysm. To over-come intraoperative hypothermia and hypoxia, we used a small membrane oxygenator with a heat exchanger in 11 patients, and postoperative recovery dramatically improved. We also developed a preassembled percutaneous cardiopulmonary support (PCPS) system with an automatic priming function using Terumo's straight path centrifugal pump and small membrane oxygenator in cooperation with the Terumo Corporation. This system was used in a patient with cardiogenic shock after acute myocardial infarction. The setup and priming took only 5 min, and 2.5-3.5 L/min of flow was obtained.     

Gyro pump wear and deformation analysis in vivo study: creep deformation

The Gyro pump has a double pivot bearing system to support its impeller. In this study, the integrity of the bearing system was examined after ex vivo studies. The pumps were implanted into calves and evaluated for different periods as a paracorporeal left ventricular assist device (LVAD). One pump was subjected to a test of 30 days, 1 for 15 days, 4 for 14 days, 1 for 10 days, 1 for 7 days, 2 for 4 days, and 4 for 2 days. One additional pump was subjected to percutaneous cardiopulmonary support (PCPS) condition for 6 days (total pressure head 500 mm Hg with a pump flow rate of 3 L/min). The anticoagulation treatment consisted of a continuous administration of heparin to maintain an achieved clotting time (ACT) of 200-250 s during the LVAD study and 250-300 s during the PCPS study. After the experiment, the pumps were disassembled, and the wear and deformation of male and female bearings were analyzed. There were no dimensional changes on male bearings but there were on female bearings. Wear and deformation of the female bearings were calculated as follows: wear and deformation = (depth of female before pumping) - (depth after pumping). Thirteen assembled Gyro pumps were disassembled to measure the depth of the female bearings before pumping. There was no statistical relationship between the wear and deformation and the motor speed x driving period. From these results, the deformation was not due to wear but to the creep or elastic deformation. This study suggested that the double pivot bearing system of the Gyro pump is highly durable.     

Emergency Cardiopulmonary Bypass Support in Patients with Cardiac Arrest Caused by Myocardial Infarction

Abstract: Emergency percutaneous cardiopulmonary bypass support (PCPS) was instituted in 3 patients with acute myocardial infarction in cardiac arrest refractory to conventional resuscitation measures. All had severe double or triple vessel disease. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 1 patient, and PTCA and directional coronary atherectomy (DCA) were performed in the other 2 patients on combined intraaortic balloon pumping (IABP) and PCPS. Flow rates of 2 to 5 L/min were achieved, with restoration of mean arterial pressure to more than 60 mm Hg during PCPS. The status of all patients was improved hemodynamically with PCPS. One patient died of hemorrhage during PCPS.
DCA was successfully performed in the other 2 patients, and PCPS and IABP was discontinued. Time on PCPS ranged from 10 h to 8 days. Time on IABP ranged from 10 days to 2 weeks. These 2 patients died of pneumonia or multiorgan failure after 1. 5 months. In conclusion, emergency PCPS is a powerful resuscitative tool that may stabilize the condition of patients in cardiac arrest to allow for definitive intervention.     

Antithrombogenicity evaluation of a centrifugal blood pump

The Gyro C1E3 pump was developed not only for cardiopulmonary bypass but also as a short-term assist device. The main purpose of this study was to examine the correlation between the thrombus formation factor and the Gyro C1E3 pumps. Seven pumps were implanted into 3 calves and evaluated for different periods of duration as a paracorporeal left ventricular assist device (LVAD). One pump was subjected to percutaneous cardiopulmonary support condition (PCPS) (total pressure head 500 mm Hg with a pump flow rate of 3 L/min). The anticoagulation treatment consisted of a continuous administration of heparin to maintain an activated clotting time (ACT) of 200-250 during the LVAD study and 250-300 during the PCPS study. After the experiment, the pumps were disassembled and examined. In cases where there were any blood-derived deposits inside the pumps, the dry weight of these thrombi that adhered to the bearing area of the pump was measured. A multiple correlation was attempted to speculate possible thrombus formation. The estimated dry weight of thrombi was calculated from pump flow rate, pumping day, motor speed, and activated clotting time. This equation was estimated dry weight of thrombi = 1.140 x pump flow rate -0.001 motor speed + 1.652 pumping time -0.041 x ACT + 2.198 R2 = 0.944. This study suggested that there was a possibility to calculate the amount of adhered thrombus formation from pump flow rate, motor speed, pumping day, and ACT.     

Experience with Emergency Cardiac Surgery Following Institution of Percutaneous Cardiopulmonary Support

Between August 1992 and February 1998, 43 patients were treated with percutaneous cardiopulmonary support (PCPS) in our institution, and 8 of them subsequently required emergency cardiac surgery. There were 3 males and 5 females with a mean age of 63 years (range, 37 to 81 years). The etiology of shock in these 8 patients was acute myocardial infarction in 3, postinfarction left ventricular (LV) free wall rupture in 1, postinfarction ventricular septal perforation (VSP) in 1, LV free wall rupture and VSP in 1, and fatal arrhythmia due to severe aortic valvular disease in 2. The mean time interval from the onset of cardiogenic shock to the institution of PCPS was 77 min (range, 18 to 183 min). The mean time interval from the institution of PCPS until surgery was 145 min (range, 40 to 603 min). The surgical procedures were coronary artery bypass grafting (CABG) in 3 patients, closure of the LV rupture and/or closure of VSP in 3, and aortic valve replacement in 2. Six patients were weaned from PCPS, and 2 patients were discharged from the hospital (discharge rate, 25%). Although the results of emergency cardiac surgery following PCPS still are not satisfactory, we continue to apply PCPS and perform appropriate surgical procedures to improve the survival rate of the patients who would die without PCPS.     

Clinical Results and Pump Analysis of the Gyro Pump for Long‐Term Extracorporeal Life Support

Rescuing patients in severe cardiac failure with extracorporeal support remains challenging. The Gyro pump is a centrifugal blood pump and was now used for cardiopulmonary bypass, although it was originally developed for long‐term cardiac assist. Little is known about clinical experiences using this pump. Here, we report on the clinical results of long‐term extracorporeal life support for over 4 days using the Gyro pump with Excelung, a hollow fiber oxygenator coated with silicone and heparin. Seven patients underwent extracorporeal life support with 15 pump and oxygenator combinations. Gyro and Excelung were used for venoarterial extracorporeal support in six patients and for right ventricular support in one patient. Patient characteristics, pump driving conditions, and blood chemistry were obtained retrospectively. All pumps were subsequently disassembled and examined macroscopically, with 6 of 15 pumps also examined by scanning electron microscopy (SEM). The patient mortality rate was 57.1%. Mean duration of support was 10.5 ± 7.2 days per pump and oxygenator combination. Lactate dehydrogenase and aspartate aminotransferase were generally maintained below 1000 and 100 IU/L, respectively, after the first 4 days of pump driving. Thrombi were found in two pumps, one used without anticoagulation and the other driven at a very slow rotational speed. SEM revealed no wear in the male bearings and very low wear and deformation (0.02 ± 0.03 mm) in the female bearings. The combination of Gyro and Excelung may be applicable for long‐term biventricular and right ventricular support, although proper anticoagulation should be administrated to avoid thrombus formation inside the pump.