Implantable left ventricular assist devices: An evolving long-term cardiac replacement therapy

Joseph DeRose, Michael Argenziano, Benjamin C. Sun, Keith Reemtsma, Mehmet C. Oz, Eric A. Rose

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective: The authors' 8-year experience with both inpatient and outpatient left ventricular assist device (LVAD) support is presented to show the possibilities and limitations of long-term outpatient mechanical circulatory assistance. Summary Background Data: The limitation of suitable cardiac donors has led to the use of LVADs as a temporizing measure for patients awaiting cardiac transplantation. The success of such devices in the short and medium term as a bridge to transplantation has led to their evaluation as a long-term destination therapy for end-stage heart disease. Methods: Between August 1990 and February 1997, 85 patients with end-stage heart disease underwent insertion of implantable LVADs. Fifty-two patients underwent pneumatic device insertion and 32 patients received a vented electric device. Results: Patients were supported for a mean of 109 ± 13 days for an overall survival to transplant (54) or explant (3) of 73%. Nineteen patients were discharged from the hospital on a mean of postoperative day 41 ± 4 (range, 17-68) for an outpatient support time of 108 ± 30 days (range, 2-466). Of 12 patients supported after postcardiotomy cardiogenic shock, 10 (82%) survived to hospital discharge. Perioperative right ventricular failure was treated in most patients with inotropic agents and inhaled nitric oxide with only six patients requiring right ventricular assist device support. Thromboembolic rate was low (0.016 events/patient- month) despite minimal or no anticoagulation in all cases. Conclusions: Left ventricular assist device support has evolved to become an outpatient therapy with excellent survival rates and an acceptable morbidity. Accordingly, wearable LVADs should be studied as permanent treatment options for patients who are not transplant candidates.

Original languageEnglish (US)
Pages (from-to)461-470
Number of pages10
JournalAnnals of Surgery
Volume226
Issue number4
DOIs
StatePublished - 1997
Externally publishedYes

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Heart-Assist Devices
Outpatients
Therapeutics
Equipment and Supplies
Heart Diseases
Transplants
Cardiogenic Shock
Patient Rights
Heart Transplantation
Inpatients
Nitric Oxide
Survival Rate
Transplantation
Tissue Donors
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Implantable left ventricular assist devices : An evolving long-term cardiac replacement therapy. / DeRose, Joseph; Argenziano, Michael; Sun, Benjamin C.; Reemtsma, Keith; Oz, Mehmet C.; Rose, Eric A.

In: Annals of Surgery, Vol. 226, No. 4, 1997, p. 461-470.

Research output: Contribution to journalArticle

DeRose, Joseph ; Argenziano, Michael ; Sun, Benjamin C. ; Reemtsma, Keith ; Oz, Mehmet C. ; Rose, Eric A. / Implantable left ventricular assist devices : An evolving long-term cardiac replacement therapy. In: Annals of Surgery. 1997 ; Vol. 226, No. 4. pp. 461-470.
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