Out-of-hospital experience in patients with implantable mechanical circulatory support: present and future trends

From March 1993 to August 1995, 33 patients received implantable VAD systems at our center. Nineteen patients received the wearable Novacor LVAS and 14 patients the TCI HeartMate device. Both systems enable the patients to be mobilized very quickly and some of them even do not require critical care after a few days. In our series 17 patients (eight Novacor, nine TCI) could be transferred to the normal floor. The wearable electrically driven Novacor system opens the opportunity of sending patients out of hospital. Since July 1994 we have referred five patients to a rehabilitation center, and six patients were sent home, three of them for more than 70 days. A number of factors are necessary to prepare the patient for being discharged. One of the most important things is to guarantee ambulatory patient care and to find an easy way for effective home monitoring. Our experience has shown that discharging these patients means giving them a maximum in quality of life and decreasing the costs by more than 50% in comparison to a stay in hospital for the whole time. Our results are encouraging to improve this strategy in the future.