Abstract
Objectives With the growing number of outpatients on ventricular assist devices (VADs), there
is an increasing need for “home discharge programs.” One important feature is a 24-hour
telephone service. In our center, the perfusionists run a so-called “hotline” for
all of our VAD patients. This study analyzes the hotline calls with regard to frequency,
the reason for calling, and the type of action undertaken.
Patients and Methods Over a period of 5 years, 16 (12 EXCOR and 4 INCOR; Berlin Heart, Berlin, Germany)
of 33 VAD patients (48%) were discharged and instructed to use the “hotline” service.
All the calls received by the perfusionists were reviewed. We classified the calls
into three levels according to the severity of the problem: Level (L) 1 = assistance
provided by the perfusionist alone; L2 = calls requiring discussion with the surgeon
on duty and/or visit to the outpatient clinic ahead of time; and L3 = immediate action
and/or admission to the hospital.
Results Over a period of 2,890 outpatient days (7.9 years), a total of 26 calls were registered.
There were 0.9 calls per 100 patient days and 1.6 calls per discharged patient. Out
of the 26 calls, 14 calls (54%) were classified as L1, 8 (31%) as L2, and 4 (15%)
as L3. The most frequent reasons for L1 or L2 calls were fibrin deposits in the EXCOR
pump chamber (39%), followed by battery dysfunction (19%). L3 calls were related to
dysfunction of the EXCOR driving units in three cases and to an EXCOR pump chamber
disconnection, which the patient did not survive.
Conclusions The institution of a hotline is an essential component of a VAD outpatient program.
It provides a certain level of safety for the patient, although a residual risk remains.
Keywords
circulatory assist devices - outcomes - postoperative care - quality of life - rehabilitation
