Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure

Rose, Eric A.; Gelijns, Annetine C.; Moskowitz, Alan J.; Heitjan, Daniel F.; Stevenson, Lynne Warner; Dembitsky, Walter P.; Long, James W.; Ascheim, Deborah D.; Tierney, Anita R.; Levitan, Ronald G; Watson, John T.; Meier, Paul; Ronan, Nuala S.; Shapiro, Peter A.; Lazar, Ronald M.; Miller, Leslie W.; Gupta, Lopa; Frazier, O.H.; Desvigne‐Nickens, Patrice; Öz, Mehmet C.; Poirier, Victor L.

doi:10.1056/nejmoa012175

Cited by 3,703 publications

(2,034 citation statements)

References 25 publications

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“…Several other studies have concluded that LVAD support is an excellent tool as bridge to transplant [9,10]. As shown by the REMATCH study [3], the role of LVAD support is not only limited as bridge to HTx but destination therapy presents itself as a promising option. The increasing demand for LVAD support has lead to the development of different systems with the main difference being their flow characteristics (pulsatile vs. continuous).…”

Section: Discussionmentioning

confidence: 97%

“…Copeland and associates [2] performed the first bridging to HTx by mechanical support in 1985. Mortality of terminal heart failure being very high as disease progresses, HTx candidates die while waiting on long lists [3,4]. According to the recently published REMATCH study [3], the use of left ventricular assist devices (LVAD) resulted in more than twice the survival rate and an improved quality of life, in comparison to optimal medical management.…”

Section: Introductionmentioning

confidence: 99%

“…Mortality of terminal heart failure being very high as disease progresses, HTx candidates die while waiting on long lists [3,4]. According to the recently published REMATCH study [3], the use of left ventricular assist devices (LVAD) resulted in more than twice the survival rate and an improved quality of life, in comparison to optimal medical management. Researchers from the Baylor College of Medicine (Houston, TX) with engineers from NASA have been developing the DeBakey LVAD produced by MicroMed Inc. since 1988 [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

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Objective: The MicroMed DeBakey left ventricular assist device (LVAD) axial blood flow pump was used as bridge to heart transplantation (HTx) in patients with terminal heart failure. The aim was to evaluate this novel mechanical circulatory support system in regard to overall outcome. Methods: Prospective study in 15 HTx candidates (mean age 40^7 years) with terminal heart failure and maximal medical treatment due to ischemic cardiomyopathy (CMP, n ¼ 5), dilated CMP ðn ¼ 3Þ, restrictive CMP ðn ¼ 2Þ, unclassified CMP ðn ¼ 1Þ, metabolic CMP ðn ¼ 1Þ, valvular CMP ðn ¼ 1Þ and congenital CMP ðn ¼ 2Þ. All patients were implanted with a MicroMed DeBakey LVAD. A rescue procedure was necessary in eight critical patients, while seven underwent elective LVAD implantation. Procedures were performed via median sternotomy, in normotherm femoro-femoral CPB (mean duration 59^1 min). Oral Marcoumar q (INR 2.0-3.0) and Aspirin q (100 mg daily) were started as soon as possible. Patients were discharged into a specialized rehabilitation clinic from which it was possible to release them home after a few weeks. Results: Successful implantation and discharge from ICU (mean stay 10^7 days) was possible in 11 patients. Seven were transplanted (mean support 50.7 days) and one is awaiting HTx (support .310 days) in the comfort of his home (NYHA I). Survival was 100% among the transplanted patients. Of the seven elective implants, five, and of the eight rescue procedures three patients underwent successful HTx. Four patients died early, while three patients died late on pump support due to intracranial hemorrhage (n ¼ 2, 73 and 76 days) and chest infection (n ¼ 1, 124 days). All survivors were discharged from hospital, with significant decrease in NYHA class (mean 3.8-2.4 ðn ¼ 11Þ). Treadmill testing showed increased exercise tolerance, from 35 to 71 W ðn ¼ 4Þ. Plasma BNP values (mean 950-162 ng/l ðn ¼ 4Þ) and pulmonary resistance (mean 316 -194.5 dyne s/cm 5 ðn ¼ 3Þ) decreased significantly during LVAD support. Conclusions: The MicroMed DeBakey LVAD is simple to implant; outpatient treatment is safe and efficient. Patients' condition and pulmonary resistances normalize within 6 weeks, making previously considered inoperable patients amenable for HTx. HTx can be performed in low-risk situation, allowing better donor -recipient matching and improving overall outcome. q

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Salzberg¹,

Lachat²,

Zünd³

et al. 2003

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

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“…Patients who were alive on LVAD therapy had significant improvements in HF symptoms (New York Heart Association class II vs IV), mood, exercise capacity, and survival (1-year survival 52% vs 25%; median survival 408 days vs 150 days). 2 The cumbersome pump size and wear and tear of the many interacting components, however, offered opportunity for device failure or pocket infection, ultimately limiting duration of therapy. The leading causes of death for patients randomized to device therapy were sepsis or pump dysfunction, with an expected mechanical pump replacement rate of 63% by 2 years in surviving patients.…”

Section: Pulsatile-flow Devicesmentioning

confidence: 99%

“…The leading causes of death for patients randomized to device therapy were sepsis or pump dysfunction, with an expected mechanical pump replacement rate of 63% by 2 years in surviving patients. 2,3 Continuous-Flow Devices Continuous-flow LVADs, or so-called second-and thirdgeneration LVADs, have been engineered to overcome some of the mechanical limitations of their pulsatile-flow predecessors. Newer-generation LVADs are engineered to minimize the interaction of moving parts, which has significantly prolonged pump durability.…”

Section: Pulsatile-flow Devicesmentioning

confidence: 99%

Implantable Mechanical Circulatory Support: Demystifying Patients With Ventricular Assist Devices and Artificial Hearts

Shah¹,

Tang²,

Cooke³

et al. 2011

Clinical Cardiology

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Engineering advancements have expanded the role for mechanical circulatory support devices in the patient with heart failure. More patients with mechanical circulatory support are being discharged from the implanting institution and will be seen by clinicians outside the immediate surgical or heart-failure team. This review provides a practical understanding of device design and physiology, general troubleshooting, and limitations and complications for implantable left ventricular assist devices (pulsatile-flow and continuous-flow pumps) and the total artificial heart.

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Integrating Palliative Care Into Heart Failure Care

Hauptman¹,

Havranek²

2005

Arch Intern Med

132

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Heart failure is a condition for which both palliative care and hospice care can be appropriate. The disease's increasing prevalence and predilection for elderly patients with significant comorbidity underscore the need to integrate these modes of care with the acute care approach that has dominated heart failure treatment. We propose integration of a palliative care approach early in the course of heart failure treatment and a tiered process for selecting patients for hospice care. A transition of the focus to palliative care rather than mortality reduction should occur over time, when clinical status deteriorates and advanced therapeutic options become inappropriate or ineffective. Failure to respond to the need for palliative care puts at risk the mandate to treat the patient with heart failure during the entire course of illness.

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Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure

Cited by 3,703 publications

References 25 publications

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Left ventricular assist device as bridge to heart transplantation – lessons learned with the MicroMed DeBakey axial blood flow pump

Implantable Mechanical Circulatory Support: Demystifying Patients With Ventricular Assist Devices and Artificial Hearts

Integrating Palliative Care Into Heart Failure Care

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