title: Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure.
abstract: BACKGROUND
  Temporary mechanical circulatory support may be indicated in some patients with cardiac failure refractory to conventional therapy, as a bridge to myocardial recovery or transplantation.
  
  
  OBJECTIVE
  To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal ventricular assist device (p-VAD).
  
  
  METHODS
  We did a retrospective analysis of demographics, clinical characteristics and survival of patients assisted with a Thoratec p-VAD.
  
  
  RESULTS
  p-VADs were used in 84 patients with cardiogenic shock secondary to acute myocardial infarction (35%), idiopathic (31%) or ischaemic (12%) cardiomyopathy, myocarditis or other causes (23%). Before implantation, 23% had cardiac arrest, 38% were on a ventilator and 31% were on an intra-aortic balloon pump. Cardiac index was 1.6+/-0.5 L/min/m(2) and total bilirubin levels were 39+/-59 micromol/L. During support, 29 patients (35%) died in the intensive care unit and seven (10%) died after leaving. Forty-seven patients (56%) were weaned or transplanted, with one still under support. Despite significantly more advanced preoperative end-organ dysfunction, survival rates were similar in patients with biventricular devices (74%) and those undergoing isolated left ventricular support (24%) (63% versus 45%, respectively; p=0.2). Actuarial survival estimates after transplantation were 78.7+/-6.3%, 73.4+/-6.9% and 62.6+/-8.3% at 1, 3 and 5 years, respectively.
  
  
  CONCLUSIONS
  Our experience validates the use of p-VAD as a primary device to support patients with cardiogenic shock. In contrast to short-term devices, p-VADs provide immediate ventricular unloading and pulsatile perfusion in a single procedure. Biventricular support should be used liberally in patients with end-organ dysfunction.
authors: Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil cedex, France. matthias.kirsch@hmn.aphp.fr
authors: Matthias
authors: M
authors: Kirsch
authors: Emmanuelle
authors: E
authors: Vermes
authors: Thibaud
authors: T
authors: Damy
authors: Kuniki
authors: K
authors: Nakashima
authors: Mélanie
authors: M
authors: Sénéchal
authors: Bernadette
authors: B
authors: Boval
authors: Ludovic
authors: L
authors: Drouet
authors: Daniel
authors: D
authors: Loisance
mesh_terms: D000293:Adolescent; D000328:Adult; D003422:Critical Care; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult