Complications of circulatory assist

Patients in whom mechanical circulatory support is indicated constitute a very special cohort who are in a multimorbid condition. Most of them either have a long history of heart failure or are in severe cardiogenic shock refractory to medical therapy and intra-aortic balloon pumping. They frequently develop secondary organ dysfunction and are in imminent risk of death prior to the implantation of the assist device, which is the only therapeutic alternative. In addition, these patients undergo a highly sophisticated operation, putting further strain on them by an extended duration of surgery and major blood loss. All these factors might influence the incidence of complications associated with heart assist devices. Since their introduction more than 20 years ago, some systems have been developed to a stage that allows the routine clinical use in many cardiosurgical centers worldwide. Several ventricular assist devices (VADs), such as Thoratec VAD (Thoratec Laboratories, Berkeley, CA, USA) Novacor left ventricular device (LVAD; Novacor-Baxter, Oakland, CA, USA) and HeartMate LVAD (Thermo Cardiosystems, Woburne, MA, USA) have even celebrated their thousandth implantation recently. In 1999, a new era of ventricular assist devices was inaugurated with the first implantations of the miniaturized DeBakey VADTM (Micromed Inc., Woodlands, TX, USA) and the fully implantable systems LionHeartTM LVD 2000 LVAD. Against the background of our 12-year experience with 450 patients, we focus our attention on the complications associated with this treatment modality and their management. Methods