Extended support with a left ventricular assist device as a bridge to heart transplantation

The Heartmate-1000IP, an intracorporeal, pneumatically activated, pulsatile left ventricular assist device (LVAD) with textured blood-contacting surfaces, is undergoing clinical evaluation as a bridge to heart transplantation (HTx). During a 3 year period (January 1988 to April 1991), the authors evaluated 12 patients who required extended LVAD support (greater than 30 days) while awaiting HTx. Duration of support ranged from 31 to 233 days (mean, 117 days). LVAD performance was excellent, with average pump flow indices of 2.5-3.5 L/min/m2. Long-term antithrombotic therapy consisted of dipyridamole and aspirin in all except one patient who received only low-molecular-weight dextran. After the initial recovery period, prothrombin and partial thromboplastin times returned to baseline levels. Plasma-free hemoglobin levels averaged less than 10 mg/dl. One patient is currently receiving support (91+ days); the 11 other patients underwent successful HTx, with follow-up ranging from 7 to 36 months. The authors' cumulative experience with this LVAD totals more than 1,506 days of support (greater than 4 years) without evidence of any thromboembolic episodes. These results suggest that this LVAD provides an effective bridge to HTx for extended periods.