IMPROVED RESULTS WITH THE NOVACOR LVAS USING NEW EPTFE INFLOW CONDUITS AND INTENSIFIED ANTICOAGULATION MANAGEMENT

Abstract

P646 Aims: The inflow conduit (IFC) of the Novacor left ventricular assist system (LVAS) has been implicated in embolic complications. We report on our single-centre experience with recently introduced ePTFE IFCs and intensified anticoagulation regimen on outcome following Novacor LVAS implantation. Methods: 33 patients implanted with the Novacor LVAS between July 1994 and February 2004 were studied and divided into two groups: group I (n=23, before 2000) received a low-porosity, woven polyester IFC or a gelatin-sealed, knitted polyester IFC. Group II (n=10, since 2000) received an ePTFE IFC. Patients in Group I were anticoagulated with phenprocoumone and acetylic acid or clopidrogel. Patients in Group II additionally received tirofiban perioperatively and after discharge INR self-monitoring was established. Results: Mean age was 43±2.5 years in Group I and 49±3.7 years in Group II, with mean LVAS support duration of 167±36 and 67±18 days respectively. The incidence of neurologic dysfunction was 8/23 (34.8%) in Group I versus 0/10 in Group II (p=0.035). Embolic cerebrovascular accidents occurred in 2/23 (8.7%) and 0/10 patients respectively (p=0.479). Cerebral hemorrhage occurred in 1/23 (4.3%) and 0/10 patients. Survival on LVAS in Group I was 65.2% and 70% in Group II. Conclusions: The combination of ePTFE IFCs and intensified anticoagulation management provided a significant reduction in neurological dysfunction without increased incidence of bleeding in our limited experience. Continuous improvements in safety performance of the Novacor LVAS increases its suitability for destination therapy.