Outpatients on mechanical circulatory support.
BACKGROUND
As waiting periods for heart transplantation have lengthened, the application of long-term mechanical circulatory support (MCS) has become more common in patients presenting with cardiogenic shock. Anticipating increased long-term MCS, a policy to discharge patients home has been instituted. This study compares the results of outpatient on MCS to a group of patients remaining hospitalized.


METHODS
We report our 10-year experience with 108 patients on MCS, who were supported for more than 3 months. Group A consisted of 38 patients (25 Novacor, 13 Berlin Heart) who underwent assist implantation from 1996 to 2001. They had a mean support time of 454 days (range 100 to 1074 days) and spent a mean of 326 days (range 20 to 769 days) at home. Group B consisted of 70 patients (24 Novacor, 46 Berlin Heart) who underwent assist implantation between 1991 and 2000. They had a mean support time of 234 days (range 95 to 795 days) and were not discharged. The patients were monitored for complications, hospital readmissions, and causes of death including infections and thromboembolic and bleeding events during the MCS time.


RESULTS
Group A total mortality was 16% (6/38). Two patients died from cerebral embolism, one from cerebral hemorrhage, two from systemic infection, and one from multiorgan failure. Thirty-two patients (84%) required 95 readmissions to the hospital due to cerebral embolism (n = 9), bleeding (n = 1), wound infections (n = 23), coagulation disorder (n = 13) for heart transplantation (n = 5), and (n = 44). In group B the mortality was 43% (30/70) for noncardiac reasons and thus significant higher (p = 0.004, chi2 test). Causes of death were cerebral embolism (n = 5), cerebral hemorrhage (n = 7), systemic infection (n = 14, significantly higher, p = 0.04, chi2 test), and multiorgan failure (n = 4).


CONCLUSIONS
Our experience demonstrates that MCS can be used in outpatients without increased mortality and with an acceptable rate of readmissions (2.8/patient). It ensures the survival of the patient, enables recovery from multiorgan failure, and offers an acceptable quality of life.
Drews
Thorsten N H
TN
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. dr.drews@berlin.de
Loebe
Matthias
M
Jurmann
Michael J
MJ
Weng
Yuguo
Y
Wendelmuth
Christoph
C
Hetzer
Roland
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000401:mortality; D003428:Cross Infection / Q000401:mortality; D005260:Female; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D020766:Intracranial Embolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D010045:Outpatients / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011474:Prosthesis Design; D012772:Shock, Septic / Q000401:mortality; D016019:Survival Analysis; D013781:Texas