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The Annals of Thoracic Surgery, Vol 53, 1080-1090, Copyright © 1992 by The Society of Thoracic Surgeons
OH Frazier, EA Rose, Q Macmanus, NA Burton, EA Lefrak, VL Poirier and KA Dasse
The Thermo Cardiosystems Inc (Woburn, MA) HeartMate 1000 IP left
ventricular assist device (LVAD) has been evaluated as a bridge to
transplantation in 34 patients for up to 324 days at seven clinical centers
in the United States. Sixty-five percent of the patients underwent
transplantation, 80% of whom were discharged from the hospital. Six
additional control patients, transplant candidates who met the entrance
criteria but who did not receive the device, were also included in the
study. Although 3 (50%) of the control patients received transplants, all 6
died within 77 days of having met the LVAD inclusion criteria (100%
mortality). Complications resulting from use of the device were comparable
with those previously reported for all ventricular assist devices, except
for thromboembolic events: bleeding, 39%; infection, 25%; and right heart
failure, 21%. No device-related thromboembolic events occurred, although 1
patient experienced an event related to a mechanical aortic valve in the
native heart. None of the complications had a significant negative
association with outcome of the patient except for right heart failure. All
survivors had a significant improvement in hepatic function before
transplantation. Total bilirubin values were reduced by 60% during LVAD
support. No significant differences were observed when total bilirubin
values were compared at 30 and 60 days after LVAD support and at 30 and 60
days after transplantation in a cohort of 15 patients (p greater than
0.05). The improvement in renal function was less predictable than that of
hepatic function. Creatinine values decreased significantly before
transplantation; however, the values measured at 30 and 60 days after
transplantation were higher than those measured at the same intervals after
LVAD support had been initiated, and this increase is presumably related to
the immunosuppressive drugs. In conclusion, the HeartMate 1000 IP LVAD has
been shown to be effective in supporting end-stage cardiomyopathy patients
to transplantation. Thromboembolism, previously regarded as a serious
complication with such devices, has not been a problem with this device.
Additional patients are being enrolled into the study to further document
the safety and effectiveness of this technology.
ARTICLES
Multicenter clinical evaluation of the HeartMate 1000 IP left ventricular assist device
Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345.
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