Long-term mechanical circulatory support in 198 patients: largest single-center experience worldwide

During recent years, mechanical circulatory support (MCS) devices have been increasingly used for long-term support. Nevertheless, problems of embolic and bleeding complication, infections, and technical failure still inhibit successful permanent support. We analyzed the courses of 198 patients who were supported for >1 year by 12 different MCS devices. Of the 198 patients, 87 had first-generation MCS devices (pulsatile), 43 second-generation devices (nonpulsatile with standard bearings), and 68 third-generation devices (nonpulsatile with magnetic bearings), implanted between July 1994 and March 2009. The mean time on support of the total group was ∼ 2 years (690 ± 321 [366-1,875] days). Of the first generation, 83 patients (95%) could be discharged; in the second and third group, all patients could be discharged. Rehospitalizations were observed in all patients. Reasons for readmission were coagulation disorders, wound infections, stroke, and technical failure. Seventy-seven patients received heart transplantation, 66 are still receiving support, 53 died, and two patients have been weaned from the device. All types of devices can be used for extended periods of time. Device- and nondevice-related rehospitalizations were observed in all three groups of patients. Close outpatient monitoring and support are crucial to ensure good long-term results.