LONG-TERM MECHANICAL CIRCULATORY SUPPORT AS A BRIDGE TO TRANSPLANTATION, FOR RECOVERY FROM CARDIOMYOPATHY, AND FOR PERMANENT REPLACEMENT

Since 1988, 295 patients have undergone RIGS at the German Heart Insti tute Berlin: 246 received biventricular support with the extracorporea l pneumatically-driven Berlin Heart assist Dcl ice. 49 received left v entricular support with implantable assist devices (33 Novacor, 16 TCI ). Longer waiting periods for heart transplantation has caused the mea n duration of MCS to increase from 12 days in 1988 to 76 days in 1994. Of the 24 patients who underwent MCS for more than 90 days, nine were implanted with a biventricular device, 12 with a Novacor device, and 15 with a TCI device. Eight patients with uni-ventricular devices rema in on support after 200 days (range 203-600 days). Six of the Novacor patients could be discharged to a nursing home or to their own residen ces. One patient still on NC support after more than 600 days currentl y resides at his home and has regained normal physical activity. Minor pocket infections occurred in two TCI and four Novacor patients: one patient died of sepsis. A total of four patients could be weaned from LVAD after 160-347 days of RIGS. An initial high level of beta(1) rece ptor antibodies disappeared completely during left ventricular support . This decline in auto-antibodies was paralleled by a dramatic improve ment in cardiac function. LVEF remained unchanged up to 6 months after explantation. Long-term mechanical support has become a reality. Hear t transplantation after prolonged RIGS yields results comparable to pr imary HTx. Some patients exhibit immunological changes and a dramatic improvement in ventricular function under long-term RIGS and can be we aned with extremely satisfying results. (C) 1997 Elsevier Science B.V.