Cardiac Support and Multiorgan Dysfunction Syndrome

Approximately 5 million Americans suffer from heart failure (HF), the burden of which will grow exponentially over the next 50 years. HF currently results in 3.5 million hospitalizations and 20% of all hospital admissions among individuals >65 years of age. Surgical interventions for HF include cardiac repair (coronary artery bypass grafting, valve repair or replacement), cardiac support (mechanical circulatory support devices) and cardiac replacement (heart transplantation). These modern interventions of cardiac surgery and critical care medicine dramatically improved outcomes. They are offered to patients with increasingly high-risk clinical profiles and a higher likelihood of complications. The development of vital-organ support therapies (respirator, dialysis, transfusion, etc) in the intensive care units (ICUs) increased the survival of critically ill patients. However, despite these organ-saving therapies, up to 15% of these patients have an unfavourable perioperative course. Frequently, more than one organ system becomes dysfunctional, leading to progressive multiorgan dysfunction (MOD) (Lietz et al., 2007). The hallmark of MOD is the development of progressive physiologic dysfunction in two or more organ systems after an acute threat to systemic homeostasis. MOD is the leading cause of morbidity and mortality in the ICUs and after mechanical circulatory support device (MCSD) implantation (Deng et al., 2005).