100 long-term implantable left ventricular assist devices: the Columbia Presbyterian interim experience.

BACKGROUND The use of left ventricular assist devices (LVADs) as bridge to transplantation is now accepted as a standard of care for a subset of end-stage heart failure patients. Our interim experience with both pneumatically and electrically powered ThermoCardiosystems LVADs is presented to outline the benefits and limitations of device support as well as discuss its potential role as bridge to recovery and as destination therapy. METHODS AND RESULTS Detailed records were kept prospectively for all patients undergoing LVAD insertion. One hundred LVADs were inserted over 7 years into 95 patients, with an overall survival rate of 75% and a transplantation rate of 70%. Four patients underwent device explant for recovered myocardial function. Three patients received LVADs as destination therapy in the ongoing REMATCH (Randomized Evaluation of Mechanical Assist Treatment for Congestive Heart failure) trial. Overall mean patient age was 51 years, and mean duration of support was 108 days. There were 25 device-related infections including the drive line, device pocket, and blood-contacting surfaces. Cerebral vascular accidents and other embolic events occurred in 7 patients with six deaths. There were four device malfunctions and nine graft-related hemorrhages, resulting in six reoperations and three deaths. CONCLUSIONS The use of long-term implantable LVADs will likely not be limited to bridge to transplantation. The REMATCH trial has commenced to study the role LVADs may have as an alternative to medical management. Furthermore, as the issues of myocardial recovery are examined, the "bridge to recovery" may be an important additional role for these assist devices.

[1]  V. Mooser,et al.  Localization of vasopressin binding sites in rat tissues using specific V1 and V2 selective ligands. , 1990, Endocrinology.

[2]  M C Oz,et al.  Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices. , 1995, Circulation.

[3]  W. Stigelman,et al.  Goodman and Gilman's the Pharmacological Basis of Therapeutics , 1986 .

[4]  J. Cohn,et al.  Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. , 1983, The American journal of cardiology.

[5]  D. Hearse,et al.  Thromboxane A2 mediates pulmonary hypertension after cardiopulmonary bypass in the rabbit. , 1993, The Journal of thoracic and cardiovascular surgery.

[6]  P. McCarthy,et al.  Preperitoneal insertion of the HeartMate 1000 IP implantable left ventricular assist device. , 1994, The Annals of thoracic surgery.

[7]  W. M. Smith Epidemiology of congestive heart failure. , 1985, The American journal of cardiology.

[8]  M C Oz,et al.  Artificial circulatory support with textured interior surfaces. A counterintuitive approach to minimizing thromboembolism. , 1994, Circulation.

[9]  M C Oz,et al.  Reversal of chronic ventricular dilation in patients with end-stage cardiomyopathy by prolonged mechanical unloading. , 1995, Circulation.

[10]  L. Garrison,et al.  Donor availability as the primary determinant of the future of heart transplantation. , 1986, JAMA.

[11]  L. Goodman,et al.  The Pharmacological Basis of Therapeutics , 1941 .

[12]  M. Vanantwerp,et al.  Epidemiology of End-Stage Heart Disease , 1991 .

[13]  John Webster,et al.  Goodman and Gilman's the Pharmacological Basis of Therapeutics, 8th ed , 1992 .

[14]  M. Oz,et al.  Malignant ventricular arrhythmias are well tolerated in patients receiving long-term left ventricular assist devices. , 1994, Journal of the American College of Cardiology.

[15]  M. Oz,et al.  Experience with right ventricular assist devices for perioperative right-sided circulatory failure. , 1996, The Annals of thoracic surgery.

[16]  F. Kottke The effects of limitation of acitivity upon the human body. , 1966, JAMA.

[17]  M. Oz,et al.  Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. , 1996, The Journal of thoracic and cardiovascular surgery.

[18]  E. Dean,et al.  Discordance between cardiopulmonary physiology and physical therapy. Toward a rational basis for practice. , 1992, Chest.

[19]  P E Leaverton,et al.  Prevalence and mortality rate of congestive heart failure in the United States. , 1992, Journal of the American College of Cardiology.

[20]  P. Rebulla,et al.  Removal of white cells from red cells by transfusion through a new filter , 1990, Transfusion.

[21]  M. Oz,et al.  Use of aprotinin in LVAD recipients reduces blood loss, blood use, and perioperative mortality. , 1995, The Annals of thoracic surgery.

[22]  R. Shenkar,et al.  Hemorrhage and resuscitation induce alterations in cytokine expression and the development of acute lung injury. , 1994, American journal of respiratory cell and molecular biology.

[23]  C. O'Callaghan Discordance between cardiopulmonary physiology and physical therapy. , 1994, Chest.