Extended cardiac support with a portable left ventricular assist system in the home

Since 1986, the HeartMate left ventricular assist system (LVAS) has been widely used as a bridge to transplantation. Recently, a multicenter study was undertaken to evaluate the safety of allowing patients supported by the vented electric (VE) LVAS to await transplantation at home. Eligible patients progressed from 1 day to 3 day passes, then were discharged from the hospital. Twenty-nine patients at four centers were evaluated for incidence of adverse events and change in quality of life. Mean time of support was 193.7 +/- 138 days (range, 35-504 days). Patients spent a total of 2,922 days at home: 344 1 day passes and 150 3 day passes were issued; 21 patients were discharged from the hospital. There were 15 readmissions to the hospital: 9 for medical reasons and 6 for device related problems. Patients were able to resolve numerous technical problems at home. No deaths occurred outside of the hospital. Two patients returned to full-time employment, and all patients resumed an active lifestyle. Although adverse events occurred, the results of this study appear to demonstrate that patients may safely await transplantation at home while supported by a HeartMate VE-LVAS.