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Ann Thorac Surg 1996;62:1321-1327
© 1996 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Low Thromboembolic Risk Without Anticoagulation Using Advanced-Design Left Ventricular Assist Devices

James P. Slater, MD, Eric A. Rose, MD, Howard R. Levin, O. H. Frazier, MD, J. Kirk Roberts, MD, Alan D. Weinberg, MS, Mehmet C. Oz, MD

Departments of Surgery, Medicine, and Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, and Texas Heart Institute, Houston, Texas

Background. A major limitation of cardiac assist devices has been the high incidence of thromboembolic events and their requirement for systemic anticoagulation. The Thermo Cardiosystems HeartMate 1000 IP left ventricular assist device (LVAD) employs a design that may reduce thromboembolic risk and obviate the need for systemic anticoagulation.

Methods. Two hundred twenty-three patients with nonreversible heart failure were supported with the HeartMate LVAD as a bridge to heart transplantation. All patients were monitored prospectively for thromboembolic events. Anticoagulation regimens and occurrence of subclinical thromboembolic events, including those seen by transcranial Doppler examinations in selected patients, were also recorded.

Results. Total time of LVAD support use was 531.2 patient-months. Twenty-three patients (10%) received warfarin postoperatively for 42.4 patient-months (8.2% of total support time). Six patients (2.7%) had thromboembolic events, representing 0.011 events per patient-month of device use.

Conclusions. The thromboembolic complication rate associated with this LVAD is acceptably low despite the minimal anticoagulation employed in this series, allowing consideration of long-term device use for the treatment of heart failure.


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Discussion
Ann. Thorac. Surg. 1996 62: 1328. [Extract] [Full Text]



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