Comparison of the CardioWest total artificial heart, the novacor left ventricular assist system and the thoratec ventricular assist system in bridge to transplantation

Background. Device selection has historically been supported by minimal com parative data. Since 1994, we have implanted 43 patients with the CardioWes t Total Artificial Heart (CW), 23 with the Novacor Left Ventricular Assist System (N), and 26 with the Thoratec Ventricular Assist System (T). This ex perience provides a basis for our device selection criteria. Methods. We reviewed retrospectively the results for survival, stroke, and infection in the CW, N, and T groups. Statistical methods included the Stud ent's t-test, x(2) analysis, and Kaplan-Meier actuarial survival curves. Results. The T group patients were younger and smaller sized than the CW or N group. The CW group had the highest mean central venous pressure (CVP) a nd lowest mean cardiac index. Survival to transplantation was 75% for CW, 5 7% for N, and 38% for T. Multiple organ failure postimplant caused most dea ths in the CW and T groups. Right heart failure and stroke caused most N de aths. Linearized stroke rates (event/patient-month) were 0.03 for CW, 0.28 for N, and 0.08 for T. Serious infections were found in 20% of CW, 30% of N , and 8% of T patients, but linearized rates showed little difference and d eath from infection was rare. Conclusions. The N device should be used in "stable" patients with body sur face area (BSA) greater than 1.7 m(2) and with minimal right heart failure. Unstable patients with biventricular failure should receive a CW if the BS A is greater than 1.7 m(2) or a T if they are smaller. (C) 2001 by The Soci ety of Thoracic Surgeons.