We. Richenbacher et Sc. Seemuth, Hospital discharge for the ventricular assist device patient: Historical perspective and description of a successful program, ASAIO J, 47(6), 2001, pp. 590-595
Patients who are supported with an implantable ventricular assist device (V
AD) as a bridge to cardiac transplantation are potential candidates for hos
pital discharge. Hospital discharge rates in reported clinical series vary
from 27% to 60%. Many of the patients included in these series, however, we
re subjects of premarket approval clinical trials and as such, are bound by
rigid eligibility criteria for discharge. According to a voluntary registr
y maintained by Thermo Cardiosystems, Inc., the postmarket discharge rate i
n patients supported with the HeartMate VE LVAS is approximately 25%, a num
ber that is artificially low due to incomplete reporting. The postmarket di
scharge rate at the busiest Thermo Cardiosystems HeartMate VE LVAS centers
is 53%. Clearly, discharge rates need to increase if the VAD is ever to be
considered a viable destination therapy for end-stage heart failure. The di
scharge program instituted at The University of Iowa incorporates patient a
nd family training as well as community services education. Between January
1999 and April 2001, fourteen patients received VAD support as a bridge to
transplantation with the HeartMate VE LVAS. Thirteen patients (93%) were d
ischarged from the hospital. Eight of the 13 patients have been transplante
d after having spent 65.8% +/- 31.4% of their period of blood pump support
as an outpatient. Eight of 13 patients (62%) required a total of 20 unplann
ed repeat hospitalizations. A well defined, aggressively implemented discha
rge program can adequately prepare the VAD patient for the transition from
hospital to home.