Experience with over 1000 implanted ventricular assist devices

PURPOSE: The use of ventricular assist devices (VADs) in patients with chronic end-stage or acute heart failure has led to improved survival. We present our experience since 1987. SUBJECTS AND METHODS: Between July 1987 and December 2006, 1026 VADs were implanted in 970 patients. Most of them were men (81.9%). The indications were: cardiomyopathy (n = 708), postcardiotomy heart failure (n = 173), acute myocardial infarction (n = 36), acute graft failure (n = 45), a VAD problem (n = 6), and others (n = 2). Mean age was 46.1 (range 3 days to 78) years. In 50.5% of the patients the VAD implanted was left ventricular, in 47.9% biventricular, and in 1.5% right ventricular. There were 14 different types of VAD. A total artificial heart was implanted in 14 patients. RESULTS: Survival analysis showed higher early mortality (p < 0.05) in the postcardiotomy group (50.9%) than in patients with preoperative profound cardiogenic shock (31.1%) and patients with preoperative end-stage heart failure without severe shock (28.9%). A total of 270 patients were successfully bridged to heart transplantation (HTx). There were no significant differences in long-term survival after HTx among patients with and without previous VAD. In 76 patients the device could be explanted after myocardial recovery. In 72 patients the aim of implantation was permanent support. During the study period 114 patients were discharged home. Currently, 54 patients are on a device. CONCLUSIONS: VAD implantation may lead to recovery from secondary organ failure. Patients should be considered for VAD implantation before profound, possibly irreversible, cardiogenic shock occurs. In patients with postcardiotomy heart failure, a more efficient algorithm should be developed to improve survival. With increased experience, more VAD patients can participate in out-patient programs.     

Transcontinental transport of a patient with an AbioMed BVS 5000 BVAD

In patients with severe cardiogenic shock requiring implantation of a short-term assist device transportation to a specialized heart center for further therapy may be necessary. We report the first successful transcontinental air transport (from Singapore to Berlin, Germany) of a patient with fulminating myocarditis requiring implantation of a biventricular assist device.     

Activated recombinant factor VII for control of diffuse bleeding after implantation of ventricular assist device

Patients with prolonged severe cardiogenic shock requiring implantation of a biventricular assist device may develop diffuse bleeding due to alteration of hepatic and renal function and subsequent coagulopathy. Bleeding control in these patients may be difficult despite massive use of blood products. We report on the successful use of recombinant activated factor VII for control of massive bleeding after implantation of a biventricular assist device in a patient with prolonged severe cardiogenic shock.     

Bloodless surgery of acute type A aortic dissection in a Jehovah's Witness patient

We report successful surgery for acute type A aortic dissection in a Jehovah's Witness patient without the use of any transfusion of allogeneic blood or blood products. We combined the normothermic cross-clamping technique with a blood conservation strategy.     

Rescue transcatheter aortic valve implantation and simultaneous percutaneous coronary intervention on cardiopulmonary bypass in a patient with an extreme risk profile

We report on successful emergency transcatheter aortic valve implantation combined with percutaneous coronary revascularization in a polymorbid and preterminal patient in profound cardiogenic shock and with multiorgan failure. The risk scores were almost unbelievably high (Society of Thoracic Surgeons mortality score, 83.9%; Society of Thoracic Surgeons morbidity and mortality score, 96.8%; logistic EuroSCORE, 96.7%). Two and a half years after the procedure, the patient is doing very well.