Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center

Objective: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center. Design: A prospective study from February 1993 to June 1999. Setting: A university hospital. Participants: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomy opathy in = 7) or ischemic heart disease (n = 3). Interventions:The patients received the TCI (Thermo Cardiosystems Inc, Wobu rn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electri c device had the pump for an extended period. Measurements and Main Results: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and ep inephrine supplemented by prostaglandin El were the most commonly used drug s to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient die d because of endovascular infection and septicemia. Infectious complication s were frequent, especially when the pump time was extended. Conclusions: The introduction of an LVAD program in a nontransplanting cent er can be achieved with good results. Intense collaboration with a transpla nt center is mandatory. The complication rate increased when treatment time s were extended. Copyright (C) 2000 by W.B. Saunders Company.