Prolonged Mechanical Circulatory Support – 1000 Days with a Left Ventricular Assist Device

Abstract

Purpose Ventricular assist devices (LVADs) are used for bridge to heart transplantation (BTR) and long term destination therapy (DT) for patients with end stage heart failure. Due to the growing number of patients with terminal heart failure and a decrease in suitable donor organs, timespans on mechanical circulatory support (MCS) of patients are continuously increasing. Methods and Materials Since 2006 283 patients received LVAD support with HeartMate II (HM2; n=160), Duraheart (DUH; n=74) and Ventrassist (VA; n=46). We analysed 34 patients (12.01%) who were supported with a device for more than 1000 days. The patients were divided into two groups, DT (n=11: VA n=5, HM2 n=4, DUH n=2) and BTR (n=22: HM2 n=9; VA n=7; DUH n=6). Patients were analysed retrospectively with regard to neurologic, infectious and gastrointestinal complications. Results Mean duration of support of all patients was 1278 days. 7 out of 34 patients, were succesfully transplanted, 4 died and 1 was successfully weaned and 22 patients are still on support. Major complications during support were driveline infections (n=7), gastrointestinal bleedings (n=7), technical failure (n=6/cable breakage n=4), neurologic events (n=6). First hospitilization after inital discharge home was after 9.8 months, the mean frequency of hospitilizations being 4.1 times. The overall mean duration of hospital stay was 65 days. Reasons for high urgency transplantation were neurologic complications (n=3; TIA,intracerebral bleeding, stroke), cable breakage (n=3) and hemolysis (n=1). Five patients expired (min. 1063days/max. 1392days) under support because of malignant tumors (n=2), late right heart failure (n=1), intracerebral bleeding (n=1) and one patient becuase of primary graft failure post heart transplantation. Conclusions In the light of substantial donor organ shortage and the growing number of heart failure patients prolonged MCS has become a more frequent treatment modality. Here we show that this can be achieved with acceptable longterm results.