Experience with over 1000 implanted ventricular assist devices.
OBJECTIVE
The use of ventricular assist devices (VADs) in patients with chronic end-stage or acute heart failure has led to improved survival. We present our experience since 1987.


METHODS
Between July 1987 and December 2006, 1026 VADs were implanted in 970 patients. Most of them were men (81.9%). The indications were: cardiomyopathy (n = 708), postcardiotomy heart failure (n = 173), acute myocardial infarction (n = 36), acute graft failure (n = 45), a VAD problem (n = 6), and others (n = 2). Mean age was 46.1 (range 3 days to 78) years. In 50.5% of the patients the VAD implanted was left ventricular, in 47.9% biventricular, and in 1.5% right ventricular. There were 14 different types of VAD. A total artificial heart was implanted in 14 patients.


RESULTS
Survival analysis showed higher early mortality (p < 0.05) in the postcardiotomy group (50.9%) than in patients with preoperative profound cardiogenic shock (31.1%) and patients with preoperative end-stage heart failure without severe shock (28.9%). A total of 270 patients were successfully bridged to heart transplantation (HTx). There were no significant differences in long-term survival after HTx among patients with and without previous VAD. In 76 patients the device could be explanted after myocardial recovery. In 72 patients the aim of implantation was permanent support. During the study period 114 patients were discharged home. Currently, 54 patients are on a device.


CONCLUSIONS
VAD implantation may lead to recovery from secondary organ failure. Patients should be considered for VAD implantation before profound, possibly irreversible, cardiogenic shock occurs. In patients with postcardiotomy heart failure, a more efficient algorithm should be developed to improve survival. With increased experience, more VAD patients can participate in out-patient programs.
Potapov
Evgenij V
EV
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany. potapov@dhzb.de
Loforte
Antonio
A
Weng
Yuguo
Y
Jurmann
Michael
M
Pasic
Miralem
M
Drews
Thorsten
T
Loebe
Matthias
M
Hennig
Ewald
E
Krabatsch
Thomas
T
Koster
Andreas
A
Lehmkuhl
Hans B
HB
Hetzer
Roland
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D016019:Survival Analysis; D016896:Treatment Outcome