Clinical Use of Cardiac Assist Devices

Considerable experience has been gained in the clinical use of cardiac assist devices at Baylor. Since 1971, close to 2000 intra-aortic balloon pumps (IABP) have been used. The roller pump was used primarily for post-cardiotomy ventricular support in 94 patients. The DeBakey ventricular assist device was used back in the 1960s in six patients, with two long-term survivors. Symbion/Jarvik total artificial hearts were used as a bridge to heart transplantation in four patients. The period of pumping varied from 3 to 105 days. The Novacor electric ventricular assist device was implanted in a total of 15 patients with ages ranging from 16 to 66 years; the pumping duration was from 1 to 155 days. Six of these patients required a BioMedicus right heart support. Of the 15 patients, 4 died on the device. There were 11 transplants; of these 11 patients, eight survived (73%). The time to transplant varied from 5 to 108 days. BioMedicus pumps were used in 148 patients aged from 15 to 84 years. The reasons for the assist were: postcardiotomy in 89, acute myocardial infarction (MI) in 9, cardiac graft failure in 21, bridge to transplant in 14, post percutaneous transluminal coronary angioplasty in 2, and other in 12. Overall, 50% of the patients died on the device, and 50% were weaned. Fifty percent died after weaning from the device, and overall discharge was 23%. These experiences indicate that circulatory assistance is feasible and effective. Mortality and complications are considerable, depending upon the stage of the patient at the time of the implant. These experiences indicate that earlier application of these devices are recommended for satisfactory outcome.