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Ann Thorac Surg 2001;71:S92-S97
© 2001 The Society of Thoracic Surgeons

Session 2: bridging to transplant and alternatives to transplant

Comparison of the CardioWest Total Artificial Heart, the Novacor Left Ventricular Assist System and the Thoratec Ventricular Assist System in bridge to transplantation

Jack G. Copeland, III, MDa, Richard G. Smith, MSEEb, Francisco A. Arabia, MDa, Paul E. Nolan, PharmDa, Vinod K. Mehta, MDa, Michael S. McCarthy, BSa, Kathleen A. Chisholm, RNb

a University of Arizona Sarver Heart Center, Tucson, Arizona, USA
b University Medical Center Artificial Heart Program, Tucson, Arizona, USA

Address reprint requests to Dr Copeland, University of Arizona Sarver Heart Center, PO Box 245071, Tucson, AZ 85724-5071
e-mail: jgc{at}u.arizona.edu

Presented at the Fifth International Conference on Circulatory Support Devices for Severe Cardiac Failure, New York, NY, Sept 15–17, 2000.

Abstract

Background. Device selection has historically been supported by minimal comparative data. Since 1994, we have implanted 43 patients with the CardioWest Total Artificial Heart (CW), 23 with the Novacor Left Ventricular Assist System (N), and 26 with the Thoratec Ventricular Assist System (T). This experience provides a basis for our device selection criteria.

Methods. We reviewed retrospectively the results for survival, stroke, and infection in the CW, N, and T groups. Statistical methods included the Student’s t-test, {chi}2 analysis, and Kaplan-Meier actuarial survival curves.

Results. The T group patients were younger and smaller sized than the CW or N group. The CW group had the highest mean central venous pressure (CVP) and lowest mean cardiac index. Survival to transplantation was 75% for CW, 57% for N, and 38% for T. Multiple organ failure postimplant caused most deaths in the CW and T groups. Right heart failure and stroke caused most N deaths. Linearized stroke rates (event/patient-month) were 0.03 for CW, 0.28 for N, and 0.08 for T. Serious infections were found in 20% of CW, 30% of N, and 8% of T patients, but linearized rates showed little difference and death from infection was rare.

Conclusions. The N device should be used in "stable" patients with body surface area (BSA) greater than 1.7 m2 and with minimal right heart failure. Unstable patients with biventricular failure should receive a CW if the BSA is greater than 1.7 m2 or a T if they are smaller.






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