Univentricular and biventricular thoratec VAD support as a bridge to transplantation

Abstract

As of October 1991, the Thoratec ventricular assist device (VAD) system has been used in 154 transplant candidates who were in imminent risk of dying before donor heart procurement at 39 medical centers in 10 countries. The VAD system consists of a prosthetic ventricle with a 65-mL pumping chamber made from Thoratec's BPS-215M polyurethane, cannulas for atrial or ventricular inflow and arterial outflow connections, and a pneumatic drive console. The devices can be used for partial or complete support of the pulmonary, systemic, or both circulations. In all patients (average age, 42 years; range, 11 to 64 years), the pumps were placed in a paracorporeal position on the anterior abdominal wall and connected to the heart and great vessels by cannulas crossing the chest wall. Biventricular support was used in 120 patients (78%) and isolated left VADs were used in 34. Average flow rate was 5.0 ± 0.9 L/min for the left VAD and 4.3 ± 0.8 L/min for the right VAD. The most frequent complications were bleeding (42% incidence, 7% mortality) and infection (36% incidence, 8% mortality). Ninety-eight patients (65%) recovered sufficiently to undergo heart transplantation after 8 hours to 226 days of support (average, 17.5 days), and 3 are waiting on VADs for transplantation. Eighty-two patients who received transplants have been discharged. This is an 84% early posttransplantation survival and a 54% overall survival. The actuarial survival 1 year after transplantation is 82%, comparable with that of conventional heart transplantation. We conclude that these heterotopic prosthetic devices provide an effective method of maintaining blood flow to vital organs until a donor heart can be procured.