Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience

Jeffrey A. Morgan, Ranjit John, Vivek Rao, Alan D. Weinberg, Brian J. Lee, Pamela A. Mazzeo, Margaret R. Flannery, Jonathan M. Chen, Mehmet C. Oz, Yoshifumi Naka

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Abstract

Objective: Implantation of a left ventricular assist device as a bridge to transplantation has become an acceptable approach for patients with end-stage heart failure. Our long-term results with 3 Thoratec HeartMate devices are presented to outline improvements in successful bridging to transplantation and post-transplant survival. Methods: From August 1990 through January 2003, 243 patients underwent implantation of Thoratec HeartMate devices as a bridge to transplantation. This included 52 (21.4%) pneumatic devices, 17 (7.0%) dual-lead vented electric devices, and 174 (71.6%) single-lead' vented electric devices. Results: Mean age was 49.7 ± 13.7 years. Mean support time was 78.1 ± 82.9 days (0-541). Bridging success increased from 63.5% (n = 33) for pneumatic devices to 64.7% (n = 11) for dual-lead vented electric devices and 72.4% (n = 126) for single-lead vented electric devices (P = .005). Posttransplant 1-, 3-, and 5-year actuarial survival increased from 87.5%, 78.1%, and 71.9% in patients with pneumatic devices to 91.5%, 86.9%, and 81.3%, respectively, for patients with single-lead vented electric devices. Device infection and malfunction occurred in 17.7% (n = 43) and 12.8% (n = 31) of patients, respectively. Conclusions: Successful bridging to transplantation and posttransplant survival has improved over time. Left ventricular assist devices have become increasingly more effective in bridging patients with end-stage heart failure to transplantation. This is likely due to a combination of better patient selection, improvements in clinical practice, and evolution in device design.

Original languageEnglish (US)
Pages (from-to)1309-1316
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume127
Issue number5
DOIs
StatePublished - May 2004

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    Morgan, J. A., John, R., Rao, V., Weinberg, A. D., Lee, B. J., Mazzeo, P. A., Flannery, M. R., Chen, J. M., Oz, M. C., & Naka, Y. (2004). Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience. Journal of Thoracic and Cardiovascular Surgery, 127(5), 1309-1316. https://doi.org/10.1016/j.jtcvs.2003.07.035