Journal article
Biventricular assist device utilization for patients with morbid congestive heart failure: A justifiable strategy
Circulation (New York, N.Y.), Vol.112(9), pp.I-65-I72
2005
DOI: 10.1161/CIRCULATIONAHA.104.524934
PMID: 16159867
Abstract
Background— The rationale for the use of a biventricular assist device (BiVAD) for morbid congestive heart failure (MCHF) has been questioned because of historically unacceptable rates of postimplant and post-transplant mortality as well as perceived barriers to their outpatient management.
Methods and Results— All patients who received a Thoratec BiVAD from January 1990 to December 2003 at the University of Pittsburgh were studied retrospectively. There were a total of 73 patients (32% ischemic, 21% idiopathic, and 47% other) who had a BiVAD implanted. Before implantation, 100% were on ≥1 inotropic agent, and 77% had an intra-aortic balloon pump. Overall survival was 69%; 42 patients (84%) received cardiac transplantation, 5 patients (10%) were weaned, and 3 (6%) remained supported on BiVAD. If the 14 patients with postcardiotomy failure and acute myocardial infarction with shock are excluded, the overall survival improves to 75%. Five-year actuarial survival after heart transplantation was 58%. Of the 29 patients implanted before 2000, the 4-month actuarial freedom from driveline infections, bloodstream infections, and neurological events was 10%, 54%, and 48%, respectively, whereas the rates of these events for the 44 patients implanted after 2000 improved to 70%, 79%, and 80%, respectively. Since 2000, 21 (48%) patients were discharged from the hospital, of whom 38% went to an outpatient residence, 33% to a skilled nursing facility, and 29% to home. Once discharged, ≥1 readmission occurred in 45% and ≥2 readmissions in 48%.
Conclusions— BiVAD support for MCHF has an acceptable overall mortality and survival to transplantation. Morbidity has been significantly reduced in the past 4 years, and management as an outpatient is achievable.
Details
- Title: Subtitle
- Biventricular assist device utilization for patients with morbid congestive heart failure: A justifiable strategy
- Creators
- Hiroyuki TSUKUI - Division of Cardiothoracic Surgery and McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesJeffrey J TEUTEBERG - Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesSrinivas MURALI - Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesDennis M MCNAMARA - Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesJulianne R BUCHANAN - Division of Cardiothoracic Surgery and McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesStephen WINOWICH - Division of Cardiothoracic Surgery and McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesEileen STANFORD - Division of Cardiothoracic Surgery and McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesMichael A MATHIER - Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesLinda M CADARET - Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Penn, United StatesRobert L KORMOS - Division of Cardiothoracic Surgery and McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Penn, United States
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.112(9), pp.I-65-I72
- DOI
- 10.1161/CIRCULATIONAHA.104.524934
- PMID
- 16159867
- NLM abbreviation
- Circulation
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Publisher
- Lippincott Williams & Wilkins
- Language
- English
- Date published
- 2005
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094758602771
Metrics
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