POTENTIAL OF LEFT-VENTRICULAR ASSIST DEVICES AS OUTPATIENT THERAPY WHILE AWAITING TRANSPLANTATION

Left ventricular assist devices (LVADs) increasingly are being used as a bridge to transplantation. We studied changes in New York Heart Ass ociation class, mean arterial pressure, resting cardiac output, end-or gan function, exercise oxygen consumption, and exercise cardiac output in 12 LVAD recipients. In addition, resting levels of neurohormonal f actors were evaluated 4 to 16 weeks after implantation. Two of the 12 patients died of right heart failure and 1 of aspiration; all deaths o ccurred in the first 2 weeks after LVAD implantation. Of the other 9 p atients, 8 improved to New York Heart Association class I and 1 to cla ss II, all of whom were in class IV preoperatively. The 4 patients who underwent exercise testing achieved an exercise oxygen consumption of 15.0 +/- 2.7 mL.kg(-1) min(-1), which was paralleled by an increase i n resting cardiac output from 3.07 +/- 0.9 L.min(-1) preoperatively to 5.66 +/- 1.1 L.min(-1) at 2 months, and mean arterial pressure from 6 0 +/- 8 to 91 +/- 10 mm Hg at 2 months, a benefit that was maintained for up to 10 months. End-organ function revealed comparable improvemen t at 2 months for both creatinine (1.68 +/- 0.7 to 1.0 +/- 0.19 mg.dL( -1)) and total bilirubin (1.37 +/- 1.17 to 0.54 +/- 0.26 mg.dL(-1)) le vels. Levels of neurohormones were within normal limits. Adverse clini cal events after the perioperative period were minimal, and no thrombo embolic complications occurred. These data indicate that functional an d physiologic recovery occurs during LVAD support, that adverse clinic al and mechanical events occurring after the perioperative period are few and should not preclude hospital discharge in selected patients, a nd thus that LVADs can provide reliable, longterm support and should b e evaluated far future use as outpatient therapy.