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HeartMate left ventricular assist device for long-term circulatory support
1Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Left ventricular assist devices (LVADs) offer safe, long-term circulatory support for end-stage heart failure patients. This study shows LVADs can improve cardiac output and allow patient recovery or bridge to transplant.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
Background:
- End-stage heart failure presents significant challenges for long-term survival.
- Left ventricular assist devices (LVADs) are crucial for mechanical circulatory support.
- Postpartum and dilated cardiomyopathies are common causes of severe heart failure.
Observation:
- Three patients with end-stage heart failure (postpartum and dilated cardiomyopathy) in cardiogenic shock received HeartMate LVADs.
- Temporary support with intra-aortic balloon pump or extracorporeal membrane oxygenation (ECMO) was utilized.
- Vascutek grafts and ECMO were employed as a bridge strategy to mitigate bleeding and right ventricular failure risks associated with LVAD implantation.
Findings:
- Successful HeartMate LVAD implantation provided stable long-term circulatory support.
- Significant increases in cardiac output were observed post-implantation (from 2.06-2.70 L/min to 4.50-5.80 L/min).
- LVAD support was achieved without the need for anticoagulation, and patients remained ambulatory.
Implications:
- HeartMate LVADs offer a safe and effective option for long-term circulatory support in severe heart failure.
- LVADs can facilitate patient recovery, enable discharge, and serve as a bridge to heart transplantation.
- Long-term ventricular unloading may promote recovery of native heart function.
Abstract:
We describe three successful cases of HeartMate left ventricular assist device (LVAD; Thermo Cardiosystems, Woburn, MA, USA) implantation in patients with end-stage heart failure for long-term circulatory support. Patient 1 was a 34-year-old woman with postpartum cardiomyopathy. Patients 2 and 3 were both males with dilated cardiomyopathy, 50 years and 21 years of age, respectively. They all presented in cardiogenic shock with decreased sensorium and anuria. Temporary mechanical support with an intra-aortic balloon pump or extracorporeal membrane oxygenation (ECMO) was needed for life support. Because bleeding and right ventricular failure often occur after HeartMate LVAD implantation, we used a Vascutek tube (Vascutek Ltd, Inchinnan, Scotland) graft to wrap inflow and outflow valve conduits and ECMO as a bridge to HeartMate LVAD implantation. Following surgery, cardiac output increased from 2.70, 2.06 and 2.53 L/min to 4.50, 5.80 and 5.00 L/min in the three patients. HeartMate LVAD can provide safe and stable long-term circulatory support without the need for anticoagulation. One of the patients remained on HeartMate for 287 days before undergoing successful heart transplantation. Patients with HeartMate LVAD are ambulatory and may be discharged while awaiting heart transplantation. Heart function may recover after long-term ventricular unloading with HeartMate LVAD.