Details

Autor(en) / Beteiligte

• Loforte, A
• Montalto, A
• Lilla della Monica, P
• Lappa, A
• Contento, C
• Menichetti, A
• Musumeci, F

Titel

Mechanical Circulatory Support in Advanced Heart Failure: Single-Center Experience

Ist Teil von

• Transplantation proceedings, 2014-06, Vol.46 (5), p.1476-1480

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Abstract Background Currently, ventricular assist device (VAD) or total artificial heart (TAH) mechanical support provides an effective treatment of unstable patients with advanced heart failure. We report our single-center experience with mechanical circulatory support therapy. Methods From March 2002 to December 2012, 107 adult patients (mean age, 56.8 ± 9.9 y; range, 31–76 y) were primarly supported on temporary or long-term VAD or TAH support as treatment for refractory heart failure at our institution. Temporary extracorporeal radial VAD support (group A) was established in 49 patients (45.7%), and long-term paracorporeal and intracorporeal VAD or TAH (group B) in 58 patients (54.2%). Left ventricular (LVAD) support was established in 55 patients (51.4%; n  = 33, Heartmate II; n  = 6, Heartmate I XVE; n  = 4, Heartware HVAD; and n  = 12, Centrimag) and biventricular (BVAD/TAH) support (group B) in 28 patients (26.1%; n  = 10, Thoratec paracorporeal; n  = 2, Heartware HVAD, n  = 1, Thoratec implantable; n  = 1, Syncardia TAH; and n  = 14, Centrimag). The temporary Centrimag was the only device adopted as isolated right ventricular (RVAD) support, and it was inserted in 24 patients (22.4%). Results In group A, overall mean support time was 10.2 ± 6.6 days (range, 3–43 d). In group B, LVAD mean support time was 357 ± 352.3 days (range, 1–902 d) and BVAD/TAH support time was 98 ± 82.6 days (range, 8–832 d). In group A, the overall success rate was 55.1% (27 patients). In group B, LVAD overall success rate was 74.4% (32 patients) and BVAD/TAH success rate was 50% (7 patients). Overall heart transplantation rate for both groups was 27.1% ( n  = 2, group A; n  = 27, group B). Overall 1-year and 5-year survivals after heart transplantation were 72.4% ( n  = 21) and 58.6% ( n  = 17), respectively. Conclusions Mechanical circulatory support is an effective strategy even in cases of end-stage heart failure according to our experience. Further improvement of VAD and TAH technologies may support their adoption as an encouraging alternative to heart transplantation in the near future.