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Ventricular assist devices as a bridge to cardiac transplantation. A prelude to destination therapy.

Abstract：

OBJECTIVE AND BACKGROUND:Ventricular assist devices (VADs) have been used for temporary circulatory support pending transplantation or recovery of the native heart. Outcome in 38 patients treated at the authors' institution with VADs pending transplantation was analyzed to provide information relevant to the future use of VADs as permanent implants. METHODS:Thoratec (Thoratec Laboratories, Pleasanton, CA) or HeartMate (Thermo Cardiosystems, Woburn, MA) VADs were used in all cases. Patients were considered for VAD placement if they were candidates for cardiac transplantation and fulfilled the criteria for the Food and Drug Administration investigational Device Exemption trials. The following adverse events were included in the analysis; death during VAD support, device malfunction, bleeding, neurologic events, support-related events that preclude transplantation, and device-related infections. Patient survival and complication rates were quantified using the Kaplan-Meier method, competing risk analysis, and hazard functions. RESULTS:Nineteen patients had transplantation. Three patients had VAD removal after cardiac recovery and 16 died without transplantation. The duration of VAD support ranged from 0 to 279 days. The hazard function for death during VAD support had an early phase that lasted for 2 weeks after VAD placement, and early death was related to the preimplant condition of the patient. Device-related infections were noted in 11 patients. Seven of these patients had transplantation after clearing the infection, whereas four died without transplantation. Neurologic events occurred in seven patients. There were no device malfunctions that led to patient death. CONCLUSIONS:The absence of fatal device malfunctions suggests that longer term support with current VAD designs is feasible. Appropriate patient selection, infection control, and avoidance of thromboembolic neurologic complications will be crucial to the success of permanent VAD use.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Holman WL,Bourge RC,Spruell RD,Murrah CP,McGiffin DC,Kirklin JK

doi

10.1097/00000658-199706000-00007

subject

Has Abstract

pub_date

1997-06-01 00:00:00

pages

695-704; discussion 705-6

issue

eissn

0003-4932

issn

1528-1140

journal_volume

225

pub_type

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Ventricular assist devices as a bridge to cardiac transplantation. A prelude to destination therapy.