Subscribe to RSS
DOI: 10.1055/s-0029-1191589
Implementation of a „chronic support“ LVAD-program in a non-transplant center
Objectives: LVAD-therapy has improved considerably during the recent years, and chronic support may be considered in carefully selected patients not eligable for HTX („destination therapy“). We report our experience with the Heartmate II (Thoratec) for destination therapy in a non-transplant center.
Methods: 5 male patients underwent implantation of a Heartmate II. All but one patient had ischemic cardiomyopathy. The median age was 70 years (min-max: 46–75yrs). Additional procedures were: CABG (n=2), tricuspid-repair (n=2), PFO-closure (n=1), and aortic-valve-replacement (n=1). Initial anticoagulation was phenprocounom plus aspirin or clopidogrel. After discharge, contact to the patients was mainly by telephone, but the patients were seen periodically as outpatients.
Results: All patients survived and were discharged home. All patients complain to some degree about orthostatic symptoms, but are free from symptoms of heart failure at moderate excertion. The median support-time is 341 days (min-max: 81–397). No device malfunction occured. However, except for the latest patient, all patients had at least one complication (after a median of 224 days, min-max: 96–278). The most frequent complication was bleeding (5 episodes which required hospitalization and/or tranfusion; 2 minor episodes). Four of the bleeding-episodes occured in the sole patient who also needed rethoracotomy for bleeding.
Conclusions: The Heartmate II can be used in severely ill, elderly patients with good results. Care for patients on destination-therapy is laborious, but does not entail special difficulties that can only be managed in heart-transplant-centers. Bleeding is the problem most often encountered. Anticoagulation requirement appears to be low and should be individualized.