Six-year experience of caring for forty-four patients with a left ventricular assist device at home: Safe, economical, necessary

Objective:With increasing numbers of implantations, left ventricular assist device programs can put a financial strain on a hospital unless an efficie nt and safe outpatient program is developed. However, the left ventricular assist device is not widely recognized in the medical community as being re liable enough to support a patient at home. We reviewed our experience with these patients at home to assess the safety and the benefits of such a pro gram, Methods: Our institutional 6-year experience with 90 consecutive reci pients of a wearable left ventricular assist device was analyzed. Results: Forty-four (49%) of the 90 patients who received TCI vented-electric left v entricular assist devices (Thermo Cardio-systems, Inc, Woburn, Mass) were d ischarged, spending a total of 4546 days (12.5 years) at home with an avera ge of 103 +/- 16 days of outpatient support (range 9-436 days). Of these 44 patients, all were successfully bridged to, transplantation (42 patients, 96%) or planned explantation (2 patients, 4%), None of the outpatients died . The cumulative events per outpatient month were 0.020 for bleeding, 0.053 for device infection, 0.0068 for thromboembolus, and 0.020 for major malfu nctions. Our estimated average cost to bridge a patient to transplantation or explantation once discharged is $13,200 and as an inpatient over the sam e length of time, including only room and board, is $165,200, Thirty percen t of outpatients were able to return to work or school, 33% to sexual activ ity, and 44% to driving. All outpatients performed activities of daily livi ng, Conclusion: Current left ventricular assist device technology provides effective and economical outpatient support and is associated with limited morbidity and a satisfactory quality of life.