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.