Outpatient left ventricular assist device support: a destination rather than a bridge.
BACKGROUND
To evaluate the feasibility and efficacy of outpatient left ventricular assist devices as a bridge to transplantation, we reviewed the initial clinical experience with this modality at our institution.


METHODS
During January 1993 to November 1995, 12 male and 2 female patients with an average age of 47 +/- 17 years were supported for an average of 117 +/- 24 days with the Thermo Cardiosystems VE wearable left ventricular assist device. Seven patients were discharged home an average of 35 +/- 4 days after implantation.


RESULTS
No device failures occurred, although 29 controller malfunctions were identified during 1,640 total support days. All patients were able to safely maintain their devices. Outflow graft bleeding and driveline infection were responsible for two readmissions. No long-term anticoagulation treatment was used; one small thromboembolic episode occurred, but without significant long-term sequelae.


CONCLUSIONS
None of the 7 patients released from the hospital died, and all were able to successfully maintain their devices at home. Hospital discharge of patients supported with left ventricular assist devices has allowed long-term evaluation of this technology, and the findings should prompt study of their use as a long-term alternative treatment to medical management for congestive heart failure.
Catanese
K A
KA
Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, New York, USA. catanes@cucis.cis.columbia.edu
Goldstein
D J
DJ
Williams
D L
DL
Foray
A T
AT
Illick
C D
CD
Gardocki
M T
MT
Weinberg
A D
AD
Levin
H R
HR
Rose
E A
EA
Oz
M C
MC
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D002303:Cardiac Output, Low / Q000209:etiology / Q000628:therapy; D004868:Equipment Failure; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011788:Quality of Life; D013997:Time Factors