100 long-term implantable left ventricular assist devices: The Columbia Presbyterian Interim Experience

Background. The use of left ventricular assist devices (LVADs) as bridge to transplantation is now accepted as a standard of care for a subset of end- stage heart failure patients. Our interim experience with both pneumaticall y and electrically powered ThermoCardiosystems LVADs is presented to outlin e the benefits and limitations of device support as well as discuss its pot ential role as bridge to recovery and as destination therapy. Methods and Results. Detailed records were kept prospectively for all patie nts undergoing LVAD insertion. One hundred LVADs were inserted over 7 years into 95 patients, with an overall survival rate of 75% and a transplantati on rate of 70%. Four patients underwent device explant for recovered myocar dial function. Three patients received LVADs as destination therapy in the ongoing REMATCH (Randomized Evaluation of Mechanical Assist Treatment for C ongestive Heart failure) trial. Overall mean patient age was 51 years, and mean duration of support was 108 days. There were 25 device-related infecti ons including the drive line, device pocket, and blood-contacting surfaces. Cerebral vascular accidents and other embolic events occurred in 7 patient s with six deaths. There were four device malfunctions and nine graft-relat ed hemorrhages, resulting in six reoperations and three deaths. Conclusions. The use of long-term implantable LVADs will likely not be limi ted to bridge to transplantation. The REMATCH trial has commenced to study the role LVADs may have as an alternative to medical management. Furthermor e, as the issues of myocardial recovery are examined, the "bridge to recove ry" may be an important additional role for these assist devices. (C) 1999 by The Society of Thoracic Surgeons.