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Isolated left ventricular assist as bridge to cardiac transplantation
V A Starnes1, P E Oyer, P M Portner
1Department of Cardiovascular Surgery, Stanford University Medical Center 94305.
Insights
The Novacor left ventricular assist device (LVAD) successfully bridged 67% of patients to cardiac transplant. This implantable device demonstrated safety and efficacy in refractory cardiogenic shock without mechanical failure.
Area of Science:
- Cardiology
- Biomedical Engineering
- Surgical Technology
Background:
- Refractory cardiogenic shock necessitates advanced mechanical circulatory support.
- Left ventricular assist devices (LVADs) offer a potential solution for end-stage heart failure.
- The Novacor implantable LVAD was evaluated for its role as a bridge to transplantation.
Purpose of the Study:
- To assess the safety and efficacy of the Novacor implantable left ventricular assist device (LVAD).
- To evaluate the Novacor LVAD's performance as a bridge to cardiac transplantation in patients with refractory cardiogenic shock.
Main Methods:
- Implantation of the Novacor LVAD in six patients with refractory cardiogenic shock.
- Monitoring of device performance, patient survival, and outcomes post-transplantation.
- Analysis of cardiac index, embolic events, and hemolysis during LVAD support.
Main Results:
- The Novacor LVAD was successfully implanted in six patients.
- Four out of six patients (67%) were successfully bridged to cardiac transplantation.
- The device functioned without mechanical or electrical failure in all cases.
- No embolic events occurred; minimal red cell hemolysis was observed.
- Assist duration ranged from 2 to 16 days, with cardiac index between 2.4-3.4 L/min/m2.
Conclusions:
- The Novacor implantable LVAD is a safe and effective option for bridging patients with refractory cardiogenic shock to cardiac transplantation.
- The device's reliability and positive patient outcomes support its use in select cardiac surgery cases.
Abstract:
The electrically driven Novacor implantable left ventricular assist device has been implanted in six patients (four men and two women) since Sept. 7, 1984. In four of the six patients (67%) the device was a successful bridge to cardiac transplantation. One patient died of multiple organ failure and Candida sepsis after 16 days of support with the device. One patient died in the operating room of uncontrollable hemorrhage and biventricular failure caused by severe cardiac rejection. Three patients are alive with cardiac transplants 38, 17, and 10 months after transplantation. One patient died after cardiac transplantation of presumed sepsis. The Novacor left ventricular assist device performed in all cases without mechanical or electrical failure. Excluding the intraoperative death, assist duration ranged from 2 to 16 days. The cardiac index (synonymous with device output) ranged from 2.4 to 3.4 L/min/m2. No embolic events (cerebrovascular or systemic) occurred during assistance with the device. Minimal red cell hemolysis was documented during the period of support. The Novacor left ventricular assist device is a safe and effective bridge to cardiac transplantation in patients with refractory cardiogenic shock.