A reliable bridge to cardiac transplantation: the TCI left ventricular assist device

The Thermo Cardiosystems (TCI) HeartMate, a pneumatically driven, implantable left ventricular assist device, was designed for long-term support of the failing heart. Between February 1990 and August 1992, the HeartMate was implanted in 11 heart transplant candidates because of profound deterioration of left ventricular function. Patients had a mean cardiac index of 1.6 L.min-1 x m-2 and a mean pulmonary capillary wedge pressure of 33 mm Hg despite maximal pharmacologic support with at least three inotropic medications. In addition, 5 patients were being supported with an intraaortic balloon pump. Nine patients were bridged successfully to cardiac transplantation. The mean cardiac index after implantation of the left ventricular assist device was 3.2 L.min-1 x m-2. Support ranged from 2 to 143 days (mean duration, 60 days). One patient died early of low output secondary to right heart failure, and a second died of air embolism, which occurred intraoperatively. All surviving patients became fully ambulatory. There were no thromboembolic complications during a total of 658 patient-days of support on a regimen of only 80 mg of aspirin daily. The 9 bridged patients are currently alive 4 to 34 months after transplantation. The TCI HeartMate provides safe and effective hemodynamic support with low risk of complications and virtual freedom from thromboembolism on a regimen of minimal anticoagulation.