RECOVERY OF MAJOR ORGAN FUNCTION IN PATIENTS AWAITING HEART-TRANSPLANTATION WITH THORATEC VENTRICULAR ASSIST DEVICES

The time course of recovery of hepatic and renal function was determin ed in 193 patients receiving Thoratec ventricular assist devices while awaiting transplantation at 41 hospitals in eight countries. The dura tion of circulatory support averaged 26 days (maximum 248 days) and th e average ventricular assist device blood flow index was 2.7 +/- 0.5 L /min/m2 compared with a preoperative cardiac index of 1.4 +/- 0.7 L/mi n/m2. Renal and hepatic function improved in most patients in 1 to 3 w eeks of support. When comparing patients with the longest durations on the ventricular assist device (60 to 248 days) to patients with the s hortest durations (<7 days), laboratory values were significantly impr oved: creatinine (-29%, from 1.7 +/- 1.2 to 1.2 +/- 0.5 mg/dl), blood urea nitrogen (-32%, from 37 +/- 27 to 25 +/- 14 mg/dl), serum glutami c-oxaloacetic transaminase (-81%, from 397 +/- 702 to 76 +/- 45 IU) an d total bilirubin (-79%, from 7.0 +/- 8.6 to 1.5 +/- 0.7 mg/dl). Howev er, the posttransplantation survival through hospital discharge was no t significantly different: 88% (14 of 16) for patients supported for a t least 60 days and 86% (43 of 50) for patients who underwent transpla ntation after only 1 week of support. Therefore renal and hepatic func tion improve during ventricular assist device support, but the surviva l rate after transplantation is not related to duration and is compara ble to that of conventional heart transplantation for short or long pe riods of ventricular assist support. Although it is clearly important not to proceed to transplantation in patients with irreversible organ failure who have ventricular assist devices, these data suggest that a s long as the patient is on the path to recovery, the outcome is basic ally the same as for patients who have full recovery of renal and hepa tic function.