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Use of a left heart assist device after intracardiac surgery: technique and clinical experience
Insights
A novel left heart assist device (LHAD) offers a less invasive removal option for patients with advanced heart disease. This innovative device shows promise in improving outcomes for critically ill individuals requiring circulatory support.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Critical Care Medicine
Background:
- Patients with advanced heart disease often experience low cardiac output post-repair, necessitating advanced circulatory support.
- Conventional support methods like intraaortic balloon counterpulsation may be insufficient or contraindicated.
- Separation from cardiopulmonary bypass can be challenging in complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel left heart assist device (LHAD) in patients with advanced heart disease and low cardiac output.
- To assess the feasibility of non-thoracotomy cannula removal for LHAD explantation.
- To determine the clinical outcomes of patients supported with the LHAD.
Main Methods:
- A left heart assist device (left atrial-ascending aorta bypass of the left ventricle) was implanted in 14 patients.
- Patients received intraoperative and postoperative support for up to 6.8 days.
- The device was explanted using a technique allowing removal without reentering the thorax.
Main Results:
- Nine out of 14 patients were successfully weaned from the LHAD.
- Six patients were discharged from the hospital.
- Four patients remained alive and improved at 22 months post-operation, demonstrating sustained benefit.
Conclusions:
- The LHAD is a viable option for patients with advanced heart disease refractory to other support methods.
- The non-thoracotomy explantation technique minimizes additional surgical risk for critically ill patients.
- The LHAD demonstrates favorable performance and potential for improved long-term outcomes in selected patients.
Abstract:
A left heart assist device (LHAD) has been employed in 14 patients. All had advanced heart disease and were in low cardiac output after repair, such that they could not be separated from cardiopulmonary bypass despite prolonged support and adjuvant therapy, including drugs, pacing, and use of intraaortic balloon counterpulsation whenever possible. Apart from special cannulas, the equipment necessary for the LHAD is widely available. An asset of the system (left atrial-ascending aorta bypass of the left ventricle) is that it may be terminated without reentering the thorax to remove the cannulas. This is accomplished with precisely fitting obturators that obliterate the cannula lumens and allow the tubes to be permanently implanted. This concept is believed important since critically ill patients requiring support are precisely those in whom added risk would be imposed by a second operation. Of the 14 patients who have had intraoperative and postoperative support (up to 6.8 days), 9 were weaned from the device and 6 were dismissed from the hospital. Four patients remain alive and are improved, the longest at 22 months since operation. The favorable performance of the LHAD suggests that it may prove useful either when intraaortic balloon counterpulsation cannot be successfully deployed or when it has failed to achieve hemodynamic stability.