Biventricular assist device utilization for patients with morbid congestive heart failure: a justifiable strategy.
BACKGROUND
The rationale for the use of a biventricular assist device (BiVAD) for morbid congestive heart failure (MCHF) has been questioned because of historically unacceptable rates of postimplant and post-transplant mortality as well as perceived barriers to their outpatient management.


RESULTS
All patients who received a Thoratec BiVAD from January 1990 to December 2003 at the University of Pittsburgh were studied retrospectively. There were a total of 73 patients (32% ischemic, 21% idiopathic, and 47% other) who had a BiVAD implanted. Before implantation, 100% were on > or =1 inotropic agent, and 77% had an intra-aortic balloon pump. Overall survival was 69%; 42 patients (84%) received cardiac transplantation, 5 patients (10%) were weaned, and 3 (6%) remained supported on BiVAD. If the 14 patients with postcardiotomy failure and acute myocardial infarction with shock are excluded, the overall survival improves to 75%. Five-year actuarial survival after heart transplantation was 58%. Of the 29 patients implanted before 2000, the 4-month actuarial freedom from driveline infections, bloodstream infections, and neurological events was 10%, 54%, and 48%, respectively, whereas the rates of these events for the 44 patients implanted after 2000 improved to 70%, 79%, and 80%, respectively. Since 2000, 21 (48%) patients were discharged from the hospital, of whom 38% went to an outpatient residence, 33% to a skilled nursing facility, and 29% to home. Once discharged, > or =1 readmission occurred in 45% and > or =2 readmissions in 48%.


CONCLUSIONS
BiVAD support for MCHF has an acceptable overall mortality and survival to transplantation. Morbidity has been significantly reduced in the past 4 years, and management as an outpatient is achievable.
Tsukui
Hiroyuki
H
Division of Cardiothoracic Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Teuteberg
Jeffrey J
JJ
Murali
Srinivas
S
McNamara
Dennis M
DM
Buchanan
Julianne R
JR
Winowich
Stephen
S
Stanford
Eileen
E
Mathier
Michael A
MA
Cadaret
Linda M
LM
Kormos
Robert L
RL
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007326:Institutionalization / Q000706:statistics & numerical data; D007423:Intra-Aortic Balloon Pumping; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome
D002317:Cardiovascular Agents