Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure

Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):509-18. doi: 10.1016/j.acvd.2009.03.010. Epub 2009 May 23.

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.

Aims: 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.

MeSH terms

  • Adolescent
  • Adult
  • Critical Care
  • Equipment Design
  • Female
  • Heart Failure / complications
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart Transplantation
  • Heart-Assist Devices* / adverse effects
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Patient Admission
  • Retrospective Studies
  • Risk Assessment
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / therapy*
  • Time Factors
  • Treatment Outcome
  • Young Adult