Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center.
OBJECTIVE
To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center.


METHODS
A prospective study from February 1993 to June 1999.


METHODS
A university hospital.


METHODS
Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3).


METHODS
The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period.


RESULTS
Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended.


CONCLUSIONS
The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.
Peterzén
B
B
Linköping Heart Center, University Hospital, Sweden.
Granfeldt
H
H
Lönn
U
U
Carnstam
B
B
Nylander
E
E
Dahlström
U
U
Rutberg
H
H
Casimir-Ahn
H
H
D000293:Adolescent; D000328:Adult; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D013318:Stroke Volume
D002316:Cardiotonic Agents