SUCCESS RATES OF LONG-TERM CIRCULATORY ASSIST DEVICES USED CURRENTLY FOR BRIDGE TO HEART-TRANSPLANTATION

Circulatory assist devices as bridge to heart transplantation have bec ome more important as the number of possible recipients has increased and the number of donors remains stable. The number of patients succes sfully bridged and discharged home after transplantation was determine d for the Novacor Left Ventricular Assist System (Baxter Healthcare Co rp., Oakland, CA) (LVAS), console and wearable; the TCl Left Ventricul ar Assist Device (Thermo Cardio Systems Inc., Woburn, MA) (LVAD), pneu matic and electric; the Thoratec LVAD and Biventricular Assist Device (Thoratec Lab Co., Berkeley, CA) (BIVAD); and the CardioWest total art ificial heart (CardioWest Tech. Inc., Tuscon, AZ) (TAH). A total of 1, 286 devices (14% Novacor console, 14% Novacor wearable, 35% TCl pneuma tic, 4% TCl electric, 10% Thoratec LVAD, 19% Thoratec BIVAD, and 4% Ca rdioWest TAH) were implanted worldwide since 1984. A total of 776 (60% ) patients reached heart transplantation and 687 patients (88.5% of th ose transplanted) were discharged home. The individual success rate fo r each device to bridge a patient to heart transplantation and be disc harged home is as follows: Novacor LVAS console, 90%; Novacor LVAS wea rable, 92%; TCl LVAD pneumatic, 89%; TCl LVAD electric, 89%; Thoratec LVAD, 93%; Thoratec BIVAD, 81%; and CardioWest TAH, 92%. The success r ate with all the available systems to bridge a patient to heart transp lantation and be discharged home is similar for all devices. The crite ria used to determine which system to be used should be individualized for each patient. Some of the factors that should be considered in ma king a decision on which device to use should include anticoagulation, univentricular vs biventricular failure, mobility, protocol to discha rge home, and size of the patient.