IMPLANTABLE LEFT-VENTRICULAR ASSIST DEVICES - AN EVOLVING LONG-TERM CARDIAC REPLACEMENT THERAPY

Objective The authors' 8-year experience with both inpatient and outpa tient left ventricular assist device (LVAD) support is presented to sh ow the possibilities and limitations of long-term outpatient mechanica l circulatory assistance. Summary Background Data The limitation of su itable cardiac donors has led to the use of LVADs as a temporizing mea sure for patients awaiting cardiac transplantation. The success of suc h devices in the short and medium term as a bridge to transplantation has led to their evaluation as a longterm destination therapy for end- stage heart disease. Methods Between August 1990 and February 1997, 85 patients with end-stage heart disease underwent insertion of implanta ble LVADs. Fifty-two patients underwent pneumatic device insertion and 32 patients received a vented electric device. Results Patients were supported for a mean of 109 +/- 13 days for an overall survival to tra nsplant (54) or explant (3) of 73%. Nineteen patients were discharged from the hospital on a mean of postoperative day 41 +/- 4 (range, 17-6 8) for an outpatient support time of 108 +/- 30 days (range, 2-466). O f 12 patients supported after postcardiotomy cardiogenic shock, 10 (82 %) survived to hospital discharge. Perioperative right ventricular fai lure was treated in most patients with inotropic agents and inhaled ni tric oxide with only six patients requiring right ventricular assist d evice support. Thromboembolic rate was low (0.016 events/patient-month ) despite minimal or no anticoagulation in all cases. Conclusions Left ventricular assist device support has evolved to become an outpatient therapy with excellent survival rates and an acceptable morbidity. Ac cordingly, wearable LVADs should be studied as permanent treatment opt ions for patients who are not transplant candidates.