Outpatients on Biventricular Assist Devices

As waiting times for transplants have lengthened, long-term mechanical circulatory support (MCS) has become more common in patients who present with severe cardiogenic shock leading to multiorgan failure. With these patients, we used the biventricular assist device (BVAD, Berlin Heart). In this report, we will describe our 4 years of experience with 11 patients on a BVAD who were discharged home while awaiting transplantation. The 11 patients underwent BVAD implantation from 1997 to 2000. These were 2 women and 9 men. The mean support time was 382 days (range: 156 - 567). The indication for BVAD was cardiomyopathy - six dilated, one restrictive and four ischemic. These patients were monitored for infections, thromboembolic events, bleeding complications, and psychological effects during the time they spent at home. Our experience shows that all of the patients could leave hospital following sufficient training for dressings and anticoagulation after recovering completely from secondary organ dysfunction. The mean time period the patients spent at home was 48 days (range: 3 - 182) days. Seven patients (63 %) had to be readmitted to the hospital - due to transitory ischemic attacks in two cases, hemorrhoidal bleeding in one and wound infections in four cases. One patient died of a traumatic accident during sexual activity. The use of a BVAD is feasible for outpatient use as a bridge to transplantation. It ensures the survival of the patient, enables recovery from multiorgan failure and offers an acceptable quality of life.

Key words:

Assist device - Biventricular mechanical circulatory support - Berlin Heart - Heart transplantation - Outpatient

References

• 1 Kaufmann F, Hennig E, Loebe M, Hetzer R. Improving the antithrombogenicity of artificial surfaces through heparin coating - clinical experience with the pneumatic extracorporeal Berlin Heart assist device.  Journal Anästhesie Intensivbeh. 1997;  4 56-60
• 2 Drews T, Loebe M, Hennig E, Kaufmann F, Müller J, Hetzer R. The ‘Berlin Heart’ assist device.  Perfusion. 2000;  15 387-396
• 3 Drews T, Loebe M, Szefner J, Hetzer R. Assistance biventriculaire de longue durée avec le système d'assistance pneumatique biventriculaire externe Berlin-Heart.  J Chir Thorac Cardio-Vasc. 2000;  4 (3) 129-136
• 4 Schiessler A, Friedel N, Weng Y, Heinz U, Hummel M, Hetzer R. Mechanical circulatory support and heart transplantation. Pre-operative status and outcome.  ASAIO J. 1994;  40 (3) M476-481
• 5 Drews T, Weng Y, Loebe M, Chavez T, Hummel M, Hetzer R. Heart transplantation after mechanical circulatory support - A 10-years experience.  Thorac Cardiovasc Surg (Abstract). 1999;  47 224
• 6 Szefner J. Control and treatment of hemostasis in cardiovascular surgery. The experience of La Pitié Hospital with patients on total artificial heart.  Int J Artif Organs. 1995;  18 (10) 633-648
• 7 Hasper D, Hummel M, Docke W D. et al . Inflammatory mediators in patients with biventricular assist device systems (Inflammatorische Mediatoren bei Patienten mit biventrikularen Assist-Device-Systemen).  Z Kardiol. 1996;  85 (11) 820-827
• 8 Himmelreich G, Ullmann H, Riess H. et al . Pathophysiologic role of contact activation in bleeding followed by thromboembolic complications after implantation of a ventricular assist device.  ASAIO J. 1995;  41 (3) M790-794
• 9 Albert W, Kiekbusch S, Köller K, Hetzer R. Quality of life with assist device. In: Hetzer R, Hennig E, Loebe M. Mechanical circulatory support.  Darmstadt; Springer-Verlag 1997: 191-205
• 10 Pennington D G, McBride L R, Kanter K R. et al . Bridging to heart transplantation with circulatory support devices.  J Heart Transplant. 1989;  8 (2) 116-123
• 11 Frazier O H, Rose E A, McCarthy P. et al . Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system.  Ann Surg. 1995;  222 327-336
• 12 McCarthy P M, Smedira N O, Vargo R L. et al . One hundred patients with the HeartMate left ventricular assist device: evolving concepts and technology.  J Thorac Cardiovasc Surg. 1988;  115 904-912