Mechanical circulatory support in severe heart failure: single-center experience.
Ventricular assist devices (VADs) have become important therapeutic tools to treat patients with end-stage cardiac failure. VADs are an essential component of transplantation programs as they successfully bridge individuals who would otherwise die. Recently left ventricular VAD (LVAD) therapy has been proposed as alternative to heart transplantation (HTx) for patients who are not transplant candidates. Other indications have now expanded into areas such as postcardiotomy failure, acute myocarditis, and acute massive myocardial infarction. From 1988 to May 2003, 80 patients received left or biventricular mechanical circulatory support including 78 as a bridge to and two as an alternative to HT. All patients survived the operation. Mean duration of VAD support was 77 +/- 150 days. Fifty-one points (63.8%) underwent heart transplantation; 3 (3.8%) recovered and were weaned from VADs. Major bleeding episodes occurred in 11 patients (13.8%) and major neurologic events occurred in 8 (10%). Sixteen patients (20%) were discharged home while waiting for HTx. Twenty-two patients (27.5%) died on VAD. In conclusion, VAD therapy proved effective in bridging patients with end-stage heart failure to HTx. While on LVAD support patients who were assisted with implantable wearable devices could be discharged at home, improving their quality of life.
Vitali
E
E
Department of Cardiac Surgery "Angelo De Gasperis," Niguarda Cà Granda Hospital, Milan, Italy. evitali@ospedaleniguarda.it
Lanfranconi
M
M
Bruschi
G
G
Ribera
E
E
Garatti
A
A
Colombo
T
T
Russo
C F
CF
D002423:Cause of Death; D006333:Heart Failure / Q000601:surgery* / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000502:physiology; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies