Nonpulsatile ventricular assist bridging to transplantation.
Six patients accepted into a cardiac transplantation program have been supported with a Biomedicus LVAD. Five of the six patients deteriorated while awaiting a donor organ; the sixth was being supported with a device following mitral valve surgery and showed no recovery of ventricular function. In all cases the device was used only after all other therapeutic modalities had failed. The periods of support ranged from 2.5 to 31 days, mean of 10 days. Three patients underwent cardiac transplantation and all three have been discharged and are well. The three survivors were supported for 2.5, 3, and 31 days. Three deaths occurred in the patients supported for 5, 9, and 15 days, the causes being sepsis, massive cerebral embolism, and respiratory failure. Patients were for the most part maintained with some degree of heparinization, and hemolysis was a significant problem in only one patient and associated with a very small arterial return cannula. Flows were routinely maintained above 2.4 L/min/m2, and all showed recovery of other organ functions while being supported. The patient supported for 31 days was capable of limited mobilization by use of the removable drive system. The Biomedicus LVAD represents a relatively inexpensive support modality for patients awaiting cardiac transplantation.
Golding
L A
LA
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44106.
Stewart
R W
RW
Sinkewich
M
M
Smith
W
W
Cosgrove
D M
DM
D000328:Adult; D001243:Assisted Circulation / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006461:Hemolysis; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D002542:Intracranial Embolism and Thrombosis; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D013997:Time Factors