Results following implantation of mechanical circulatory support systems: the Montreal Heart Institute experience.
BACKGROUND
Mechanical circulatory support systems (MCSS) have been available in Canada since 1986. Accepted indications include bridging to transplantation or recovery. The present study reviewed the results following MCSS implantation at the Montreal Heart Institute (Montreal, Quebec).


METHODS
From September 1987 to September 2006, 43 MCSS were implanted (32 Thoratec [Thoratec Corporation, USA], nine CardioWest TAH [SynCardia Systems Inc, USA], two Novacor [WorldHeart Corporation, Canada]) in 43 patients (mean [+/- SD] age 44+/-13 years; range 19 to 64 years). Indications for implantation included cardiogenic shock due to ischemic (n=19), viral (n=10) or other types of cardiomyopathies (n=14).


RESULTS
The mean ejection fraction before implantation was 17.6+/-6.5% (range 10% to 45%). Before MCSS implantation, most patients showed signs of end-organ failure, including mechanical ventilation (77%), central venous pressure higher than 16 mmHg (44%), oliguria (35%) and hepatic dysfunction (19%). The mean duration of MCSS support was 22.8+/-32.8 days (range one to 158 days). Survival to transplantation or recovery was 74%. Only one patient was successfully bridged to recovery. Complications were common during MCSS support. They included reexploration for bleeding (47%), respiratory failure (44%), renal failure requiring temporary dialysis (40%), infection (33%) and neurological events (16%). Only one patient had device failure. In patients successfully bridged to transplantation, early actuarial survival (one month) following transplantation averaged 71+/-8% and was 57+/-9% at one year.


CONCLUSIONS
MCSS support with a left ventricular assist device or a total artificial heart provides an effective means of bridging terminally ill patients to transplantation or recovery. Early survival after transplantation shows satisfactory results. However, these results come at the expense of frequent device-related complications, and device failure remains a constant threat.
El-Hamamsy
Ismaïl
I
Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec.
Jacques
Frédéric
F
Perrault
Louis P
LP
Bouchard
Denis
D
Demers
Pphilippe
P
White
Michel
M
Pelletier
Guy B
GB
Racine
Normand
N
Pellerin
Michel
M
Carrier
Michel
M
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*