EMERGENCY VERSUS ELECTIVE URGENT LEFT-VENTRICULAR ASSIST DEVICE IMPLANTATION/

Background: The risk and outcome in patients undergoing left ventricul ar assist device (LVAD) implantation on an emergency basis is still un clear. Methods: Since April 1993, 40 patients received a Novacor and 8 patients a Heartmate LVAD in our institution. Patients with emergency LVAD placement were compared with the remainder in a retrospective ma nner. Parameters studied included underlying heart disease, preimplant ation dysfunction of kidney, liver, lung, and cerebrum, interval of me chanical support, outcome, and complications. Results: Patients with e mergency LVAD placement predominantly were seen with postcardiotomy he art failure (47%) or acute myocarditis (20%) (group A) whereas electiv e and urgent candidates for LVAD implantation mainly had dilative card iomyopathy (67%) or ischemic heart disease (30%) (group B). The incide nce of secondary organ failure was significantly higher for all organs in group A patients (p <.01). Mean support interval in patients who u nderwent emergency LVAD implantation was lower (74 +/- 79 days vs 115 +/- 80 days), and fewer patients could be forwarded to heart transplan tation in this group (22% vs 78%, p <.01). Moreover, bleeding complica tions were increased in group A (66% vs 30%, p <.01), but not thromboe mbolism and infection. Conclusion: In conclusion, the overall success rate after emergency LVAD implantation was lower, with bleeding being the most frequent complication. To achieve acceptable outcomes in disa strous situations, LVADs should be placed as early as possible.