PREOPERATIVE AND POSTOPERATIVE COMPARISON OF PATIENTS WITH UNIVENTRICULAR AND BIVENTRICULAR SUPPORT WITH THE THORATEC VENTRICULAR ASSIST DEVICE AS A BRIDGE TO CARDIAC TRANSPLANTATION

Objectives: The goal of this study was to determine whether there are differences in populations of patients with heart failure who require univentricular or biventricular circulatory support, Methods: Two hund red thirteen patients who were in imminent risk of dying before donor heart procurement and who received Thoratec left (LVAD) and right (RVA D) ventricular assist devices at 35 hospitals were divided into three groups: group 1 (n = 74), patients adequately supported with isolated LVADs; group 2 (n = 37), patients initially receiving an LVAD and late r requiring an RVAD; and group 3 (n = 102), patients who received bive ntricular assistance (BiVAD) from the beginning, Results: There were n o significant differences in any preoperative factors between the two BiVAD groups, In the combined BiVAD groups, pre-VAD cardiac index (BiV AD, 1.4 +/- 0.6 L/min per square meter, vs LVAD, 1.6 +/- 0.6 L/min per square meter) and pulmonary capillary wedge pressure (BiVAD, 27 +/- 8 mm Hg, vs LVAD, 30 +/- 8 mm Hg) were significantly lower than those i n the LVAD group, and pre-VAD creatinine levels were significantly hig her (BiVAD, 1.9 +/- 1.1 mg/dl, vs LVAD, 1.4 +/- 0.6 mg/dl). In additio n, greater proportions of patients in the BiVAD groups required mechan ical ventilation before VAD placement (60% vs 35%) and were implanted under emergency conditions than in the LVAD group (22% vs 9%), The sur vival of patients through heart transplantation was significantly bett er in patients who had an LVAD) (74%) than in those who had BiVADs (58 %), However, there were no significant differences in posttransplantat ion survival through hospital discharge (LVAD, 89%; BIVAD, 81%). Concl usion: Patients who received LVADs were less severely ill before the o peration and consequently were more likely to survive after the operat ion, As the severity of illness increases, patients are more likely to require biventricular support.