Midterm follow-up of patients discharged from hospital under left ventricular assistance

Background: Against the background of increasing demand for long-term mecha nical circulatory support, discharging patients to their homes while on ass ist devices becomes more and more important. This report describes the midt erm follow-up of 66 patients who were allowed to leave the hospital under l eft ventricular assist device (LVAD) support with Novacor or HeartMate syst ems. Methods: Between May 1994 and January 2000, 66 patients (9 women, 57 men, b etween 15 and 68 years old) under LVAD support fulfilled our criteria for b eing discharged home on the device. Intent to treat comprised bridging to t ransplantation in 59 patients, bridging to recovery in 5 patients, and alte rnative to transplantation in 2 patients. Forty-four patients received supp ort with Novacor, 18 patients with the VE HeartMate, 2 patients with centri fugal pumps and Novacor, and 1 patient each with Novacor and Thoratec/Medos HIA-VAD. Results: The mean out-of-hospital (OOH) follow-up period was 162 +/- 187 da ys, with a cumulative OOH experience of 30 patient years. Twenty-nine patie nts were not readmitted, and 37 patients were readmitted 54 times (23 patie nts were readmitted once, 11 patients twice, and 3 patients 3 times). The p rimary reasons for readmission included neurologic disorders and infection complications. At 229 days, 50% of all patients were free from readmission. The readmission rate was 1.8 patient/year. Sixteen patient died while on L VAD support (24%). Conclusions: Our midterm follow-up results show the safety and efficacy of this therapeutic option. Acceptable hospital readmission rates strongly sup port the future use of this technology as an alternative to transplantation in managing end-stage heart failure patients.