title: Thoratec implantable ventricular assist device: the Papworth experience.
abstract: OBJECTIVE
  The Thoratec (Thoratec Corp, Pleasanton, Calif) implantable ventricular assist device (IVAD) can be used for univentricular or biventricular support. The objective of this study is to review the 5-year experience of bridging patients to heart transplantation with this device in a single center. Surgical aspects, including hybrid pump pocket, double tunneling of driveline, and optimal cannulae placement, are discussed.
  
  
  METHODS
  This is a retrospective review of 24 patients treated between January 2002 and December 2007. Nineteen patients (79.1%) received a single implantable ventricular assist device as left ventricular assist devices, and 5 patients (21.9%) received 2 implantable ventricular assist devices as biventricular assist devices. The devices were implanted in pre-peritoneal/posterior rectus hybrid pump pockets. The driveline was passed through a 2-stage double-tunnel to exit onto the lateral chest wall. Patients were anticoagulated with Warfarin aiming for an international normalized ratio of 2.0 to 3.0.
  
  
  RESULTS
  Twenty male and 4 female patients with a mean age of 39.8 years (17-57 years) and a body surface area of 1.87 m(2) (1.63-2.2 m(2)) were supported for a total of 2308 patient-days. Mean duration of support was 96 days (10-301 days). The cause of heart failure was dilated cardiomyopathy in 18 patients and ischemic cardiomyopathy in 6 patients. Preoperatively, 23 patients were receiving inotropes, 12 patients required intra-aortic balloon pump support, 5 patients were intubated and mechanically ventilated, and 3 patients required continuous venovenous hemofiltration for renal support. Eleven patients (45.8%) were discharged with ventricular assist device support (1015 home patient-days). Complications observed were a) neurologic: stroke in 3 patients, transient ischemic attacks in 4 patients; and b) infection: driveline infection in 3 patients and pump pocket infection in 1 patient. There was no mechanical device failure. Support to transplantation was achieved in 17 patients (70.8%): 3 of 5 biventricular assist devices (60%) and 14 of 19 left ventricular assist devices (73.7%).
  
  
  CONCLUSIONS
  The Thoratec IVAD is a versatile and reliable ventricular assist device. It can provide univentricular or biventricular support for bridging patients to heart transplantation with acceptable complication rates. The portable Thoratec TLC-II console facilitated discharge while patients waited for a suitable donor heart.
authors.affiliation: Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
authors.forename: Marius
authors.initials: M
authors.lastname: Berman
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: David P
authors.initials: DP
authors.lastname: Jenkins
authors.forename: Kumud
authors.initials: K
authors.lastname: Dhital
authors.forename: Clive
authors.initials: C
authors.lastname: Lewis
authors.forename: Kirsty
authors.initials: K
authors.lastname: Dempster
authors.forename: Paul
authors.initials: P
authors.lastname: Lincoln
authors.forename: Catherine
authors.initials: C
authors.lastname: Sudarshan
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Large
authors.forename: John
authors.initials: J
authors.lastname: Dunning
authors.forename: Steven S L
authors.initials: SS
authors.lastname: Tsui
mesh_terms: D000293:Adolescent; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult