Thorac Cardiovasc Surg 2010; 58: S173-S178
DOI: 10.1055/s-0029-1240687
Originals

© Georg Thieme Verlag KG Stuttgart · New York

Partial Mechanical Long-Term Support with the CircuLite® Synergy® Pump as Bridge-to-Transplant in Congestive Heart Failure

S. Klotz1 , B. Meyns2 , A. Simon3 , T. Wittwer4 , P. Rahmanian4 , C. Schlensak5 , T. T. D. T. Tjan1 , H. H. Scheld1 , D. Burkhoff6 , 7
  • 1Department of Thoracic and Cardiovascular Surgery, University Hospital of Muenster, Muenster, Germany
  • 2Department of Cardiac Surgery, University Hospital, Gasthuisberg Leuven University, Leuven, Belgium
  • 3Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
  • 4Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
  • 5Department of Cardiovascular Surgery, University Clinic Freiburg, Freiburg, Germany
  • 6CircuLite Inc., Saddle Brook, NJ, USA
  • 7Division of Cardiology, Columbia Presbyterian Medical Center, New York, NY, USA
Further Information

Publication History

Publication Date:
25 January 2010 (online)

Abstract

Background: Full mechanical support with a left ventricular assist device (LVAD) is often limited to very sick patients, as the only survival option. This European multicenter study analyzes the effect of partial mechanical support as bridge-to-transplant in a less sick heart failure patient group. Methods: The CircuLite® Synergy® device is implanted via a small right-sided thoracotomy with an inflow cannula in the left atrium and an outflow graft connected to the right subclavian artery without the use of extracorporeal circulation. The pump itself sits in a “pacemaker” pocket subcutaneously in the right clavicular groove. It is able to pump up to 3.0 l/min and partially unload the left ventricle. Results: The device was implanted in 25 patients on the cardiac transplant waiting list (20 males), aged 55.5 ± 9.6 yrs with an ejection fraction of 21.6 ± 6.0 %, a mean arterial pressure of 73.5 ± 8.5 mmHg, a pulmonary capillary wedge pressure of 27.2 ± 7.8 mmHg and cardiac index of 1.9 ± 0.4 l/min/m2. Duration of support ranged from 6 to 238 days. Right heart catheterization showed significant hemodynamic improvement in the short- and intermediate-term after implantation with increases in arterial pressure from 72.6 ± 11.0 to 79.4 ± 8.6 mmHg (p = 0.04) and in cardiac index from 2.0 ± 0.4 to 2.7 ± 0.6 l/min/m2 (p = 0.003) with a reduction in pulmonary capillary wedge pressure from 28.5 ± 6.0 to 19.7 ± 6.9 mmHg (p = 0.012). Conclusions: The CircuLite Synergy device is a partial support pump, which is easy to implant and which provides hemodynamic benefits in bridging heart failure patients to cardiac transplant.

References

  • 1 Eurotransplant International Foundation .Eurotransplant annual report 2008. http://www.eurotransplant.nl
  • 2 Koch A, Tochtermann U, Remppis A et al. The Eurotransplant high-urgency heart transplantation program: an option for patients in acute heart failure?.  Thorac Cardiovasc Surg. 2006;  54 414-417
  • 3 Levy W C, Mozaffarian D, Linker D T et al. The Seattle heart failure model: prediction of survival in heart failure.  Circulation. 2006;  113 1424-1433
  • 4 Matthews J C, Dardas T F, Aaronson K D. Heart transplantation: assessment of heart failure mortality risk.  Curr Heart Fail Rep. 2007;  4 103-109
  • 5 Smits J M, Deng M C, Hummel M et al. A prognostic model for predicting waiting-list mortality for a total national cohort of adult heart-transplant candidates.  Transplantation. 2003;  76 1185-1189
  • 6 Kamiya H, Koch A, Sack F U et al. Who needs ‘bridge to transplantation in the presence of the Eurotransplant high-urgency heart transplantation program?.  Eur J Cardiothorac Surg. 2008;  34 1129-1133
  • 7 Klotz S, Vahlhaus C, Riehl C, Reitz C, Sindermann J, Scheld H H. Preoperative prediction of post VAD implant mortality using easily accessible clinical parameter.  J Heart Lung Transplant. 2009;  , [Epub ahead of print]
  • 8 Lietz K, Miller L W. Patient selection for left-ventricular assist devices.  Curr Opin Cardiol. 2009;  24 246-251
  • 9 Miller L W, Lietz K. Candidate selection for long-term left ventricular assist device therapy for refractory heart failure.  J Heart Lung Transplant. 2006;  25 756-764
  • 10 Morley D, Litwak K, Ferber P et al. Hemodynamic effects of partial ventricular support in chronic heart failure: results of simulation validated with in vivo data.  J Thorac Cardiovasc Surg. 2007;  133 21-28
  • 11 Meyns B, Ector J, Rega F et al. First human use of partial left ventricular heart support with the Circulite synergy micro-pump as a bridge to cardiac transplantation.  Eur Heart J. 2008;  29 2582
  • 12 Komoda T, Hetzer R, Lehmkuhl H B. Influence of new Eurotransplant heart allocation policy on outcome of heart transplant candidates in Germany.  J Heart Lung Transplant. 2008;  27 1108-1114

Stefan Klotz, MD

Department of Thoracic and Cardiovascular Surgery
University Hospital Muenster

Albert-Schweitzer-Str. 33

48149 Muenster

Germany

Phone: + 49 25 18 34 74 01

Fax: + 49 25 18 34 83 16

Email: Stefan.Klotz@ukmuenster.de

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