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The Annals of Thoracic Surgery, Vol 47, 142-150, Copyright © 1989 by The Society of Thoracic Surgeons
PM Portner, PE Oyer, DG Pennington, WA Baumgartner, BP Griffith, WR Frist, DJ Magilligan Jr, GP Noon, N Ramasamy and PJ Miller
An implantable left ventricular assist system (LVAS) utilizing an
electromechanically driven dual pusher-plate blood pump has been employed
in a multiinstitutional trial as a bridge to cardiac transplantation. Under
development for permanent circulatory support in patients with end-stage
heart disease, the LVAS, in this application, derives power and control
from an external console via a percutaneous lead. The LVAS was implanted in
20 patients (16 men, 4 women) who were hemodynamically unstable or in
refractory cardiogenic shock. The mean age was 44.9 years (range, 25 to 63
years). Preoperative diagnosis was evenly divided between end-stage
ischemic disease, cardiomyopathy, and acute myocardial infarction.
Implanted in the left upper quadrant within the anterior abdominal wall,
the blood pump was connected between the left ventricular apex and
ascending aorta. Total support of the systemic circulation and substantial
left ventricular unloading were achieved with synchronous counterpulsation
for periods up to 90 days (mean, 22.7 days). All patients were stabilized
hemodynamically. The mean preoperative cardiac index of 1.5 L/min/m2
increased by a factor of 2. Pulmonary arterial pressures decreased
substantially. Serious complications occurred in 16 patients, precluding
cardiac transplantation in 10. Most complications (greater than 70%) were
in patients who did not receive transplants; the most common complication
was bleeding. Twelve of 13 patients with LVAS implants for more than seven
days were mobilized, and 4 were fully ambulatory and completely
rehabilitated. Orthotopic cardiac transplantation was performed in 10
patients after implants ranging from two to 90 days (mean, 30.3
days).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Implantable electrical left ventricular assist system: bridge to transplantation and the future
Stanford University Medical Center, California.
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