LOW THROMBOEMBOLIC RISK WITHOUT ANTICOAGULATION USING ADVANCED-DESIGNLEFT-VENTRICULAR ASSIST DEVICES

Background. A major limitation of cardiac assist devices has been the high incidence of thromboembolic events and their requirement for syst emic anticoagulation. The Thermo Cardiosystems HeartMate 1000 IP left ventricular assist device (LVAD) employs a design that may reduce thro mboembolic risk and obviate the need for systemic anticoagulation. Met hods. Two hundred twenty-three patients with nonreversible heart failu re were supported with the HeartMate LVAD as a bridge to heart transpl antation. All patients were monitored prospectively for thromboembolic events. Anticoagulation regimens and occurrence of subclinical thromb oembolic events, including those seen by transcranial Doppler examinat ions in selected patients, were also recorded. Results. Total time of LVAD support use was 531.2 patient-months. Twenty-three patients (10%) received warfarin postoperatively for 42.4 patient-months (8.2% of to tal support time). Six patients (2.7%) had thromboembolic events, repr esenting 0.011 events per patient-month of device use. Conclusions. Th e thromboembolic complication rate associated with this LVAD is accept ably low despite the minimal anticoagulation employed in this series, allowing consideration of long-term device use for the treatment of he art failure.