title: Mechanical circulatory support in advanced heart failure: single-center experience.
abstract: BACKGROUND
  Currently, ventricular assist device (VAD) or total artificial heart (TAH) mechanical support provides an effective treatment of unstable patients with advanced heart failure. We report our single-center experience with mechanical circulatory support therapy.
  
  
  METHODS
  From March 2002 to December 2012, 107 adult patients (mean age, 56.8 ± 9.9 y; range, 31-76 y) were primarly supported on temporary or long-term VAD or TAH support as treatment for refractory heart failure at our institution. Temporary extracorporeal radial VAD support (group A) was established in 49 patients (45.7%), and long-term paracorporeal and intracorporeal VAD or TAH (group B) in 58 patients (54.2%). Left ventricular (LVAD) support was established in 55 patients (51.4%; n = 33, Heartmate II; n = 6, Heartmate I XVE; n = 4, Heartware HVAD; and n = 12, Centrimag) and biventricular (BVAD/TAH) support (group B) in 28 patients (26.1%; n = 10, Thoratec paracorporeal; n = 2, Heartware HVAD, n = 1, Thoratec implantable; n = 1, Syncardia TAH; and n = 14, Centrimag). The temporary Centrimag was the only device adopted as isolated right ventricular (RVAD) support, and it was inserted in 24 patients (22.4%).
  
  
  RESULTS
  In group A, overall mean support time was 10.2 ± 6.6 days (range, 3-43 d). In group B, LVAD mean support time was 357 ± 352.3 days (range, 1-902 d) and BVAD/TAH support time was 98 ± 82.6 days (range, 8-832 d). In group A, the overall success rate was 55.1% (27 patients). In group B, LVAD overall success rate was 74.4% (32 patients) and BVAD/TAH success rate was 50% (7 patients). Overall heart transplantation rate for both groups was 27.1% (n = 2, group A; n = 27, group B). Overall 1-year and 5-year survivals after heart transplantation were 72.4% (n = 21) and 58.6% (n = 17), respectively.
  
  
  CONCLUSIONS
  Mechanical circulatory support is an effective strategy even in cases of end-stage heart failure according to our experience. Further improvement of VAD and TAH technologies may support their adoption as an encouraging alternative to heart transplantation in the near future.
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy. Electronic address: antonioloforte@yahoo.it.
authors.forename: A
authors.initials: A
authors.lastname: Loforte
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Montalto
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Lilla della Monica
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lappa
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Contento
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Menichetti
authors.affiliation: Department of Cardiac Surgery and Transplantation, S Camillo Hospital, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Musumeci
mesh_terms: D000328:Adult; D000368:Aged; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006354:Heart, Artificial; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged