OUTPATIENT LEFT-VENTRICULAR ASSIST DEVICE SUPPORT - A DESTINATION RATHER THAN A BRIDGE

Background. To evaluate the feasibility and efficacy of outpatient lef t ventricular assist devices as a bridge to transplantation, we review ed the initial clinical experience with this modality at our instituti on. Methods. During January 1993 to November 1995, 12 male and 2 femal e patients with an average age of 47 +/- 17 years were supported for a n average of 117 +/- 24 days with the Thermo Cardiosystems VE wearable left ventricular assist device. Seven patients were discharged home a n average of 35 +/- 4 days after implantation. Results. No device fail ures occurred, although 29 controller malfunctions were identified dur ing 1,640 total support days. All patients were able to safely maintai n their devices. Outflow graft bleeding and driveline infection were r esponsible for two readmissions. No longterm anticoagulation treatment was used; one small thromboembolic episode occurred, but without sign ificant long-term sequelae. Conclusions. None of the 7 patients releas ed from the hospital died, and all were able to successfully maintain their devices at home. Hospital discharge of patients supported with l eft ventricular assist devices has allowed long-term evaluation of thi s technology, and the findings should prompt study of their use as a l ong-term alternative treatment to medical management for congestive he art failure.