Hr. Levin et al., POTENTIAL OF LEFT-VENTRICULAR ASSIST DEVICES AS OUTPATIENT THERAPY WHILE AWAITING TRANSPLANTATION, The Annals of thoracic surgery, 58(5), 1994, pp. 1515-1520
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.