Left ventricular assist device as bridge to transplantation in patients with end-stage heart failure: Eight-year experience with the implantable HeartMate LVAS

Abstract

Objective: To evaluate the use of left ventricular assist devices (LVAD) as bridge to heart transplantation (HTx) in patients with end-stage heart failure.

Method: Between March 1993 and December 2001, 38 patients with refractory end-stage heart failure underwent HeartMate LVAD (Thoratec, Pleasanton Calif.) implantation.

Results: A total of 33 of the 38 patients (87%) survived the implantation and perioperative period. There were five perioperative deaths (13%), two due to right ventricular failure, two as a result of bleeding and one probably due to septic shock at the time of LVAD implantation. Three patients (9%) died late in the postoperative period due to septic shock, mechanical failure of the device and a cerebral embolus resulting from LVAD endocarditis, initiated by an acute cholecystitis. Twelve patients (32%) had one or more infectious episodes during long-term assist, of which one patient died. Four patients are still on the device, waiting for a heart transplantation. Twenty-six patients (76%) underwent HTx after 206±129 days of support.

Conclusion: These results show the efficacy of LVAD support as a bridge to heart transplantation in patients with end-stage heart failure. Major long-term complications are infections and mechanical failure of the device.

Keywords: heart failure; heart transplantation; left ventricular assist devices.