Device and patient management in a bridge-to-transplant setting

Citation
A. El-banayosy et al., Device and patient management in a bridge-to-transplant setting, ANN THORAC, 71(3), 2001, pp. S98-S102
Citations number
14
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Journal title
ANNALS OF THORACIC SURGERY
ISSN journal
00034975 → ACNP
Volume
71
Issue
3
Year of publication
2001
Supplement
S
Pages
S98 - S102
Database
ISI
SICI code
0003-4975(200103)71:3<S98:DAPMIA>2.0.ZU;2-L
Abstract
Background. A variety of sophisticated devices have been developed for mech anical circulatory support in patients bridged to cardiac transplantation. Based on 13 years' experience, we have developed specific protocols for pat ient selection and management for different devices. Methods. The principal systems applied in the bridge-to-transplant cohort a re the Thoratec ventricular assist device (n = 144, mean duration of suppor t 53 +/- 57 days), the Novacor left ventricular assist system (LVAS) (n = 8 5, mean duration of support 154 +/- 15 days), and the HeartMate LVAS (n = 5 4, mean duration of support 143 +/- 142 days). The Thoratec device is used for biventricular assistance or if the duration of support is expected to b e less than 6 months. For long-term support, either the Novacor or HeartMat e LVAS are preferred. Results. Despite careful postoperative patient management, this group of pa tients is prone to a variety of complications. Bleeding occurred in 22% to 35%, right heart failure in 15% to 26%, neurologic disorders in 7% to 28%, infection in 7% to 30%, and liver failure in 11% to 20% of patients. Compli cations varied with the device applied and the patient's preoperative condi tion. A total of 73 patients were discharged from hospital for a mean perio d of 184 days; this cumulative experience amounted to 37.5 patient-years. Conclusions. The Novacor and the HeartMate systems offer the additional pos sibility of discharging patients during support if they fulfill certain cri teria. The main reasons for rehospitalization were thromboembolic and infec tious complications. (C) 2001 by The Society of Thoracic Surgeons.