Single-centre experience with the Thoratec® paracorporeal ventricular assist device for patients with primary cardiac failure

Background. - Temporary mechanical circulatory support may be indicated in some patients with cardiac failure refractory to conventional therapy, as a bridge to myocardial recovery or transplantation. Aims. - To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal. ventricular assist device (p-VAD). Methods. - We did a retrospective analysis of demographics, clinical characteristics and survival. of patients assisted with a Thoratec (R) p-VAD. Results. - p-VADs were used in 84 patients with cardiogenic shock secondary to acute myocardial infarction (35%), idiopathic (31%) or ischaemic (12%) cardiomyopathy, myocarditis or other causes (23%). Before implantation, 23% had cardiac arrest, 38% were on a ventilator and 31% were on an intra-aortic balloon pump. Cardiac index was 1.6 +/- 0.5 L/min/m(2) and total bilirubin levels were 39 +/- 59 mu mol/L. During support, 29 patients (35%) died in the intensive care unit and seven (10%) died after leaving. Forty-seven patients (56%) were weaned or transplanted, with one still under support. Despite significantly more advanced preoperative end-organ dysfunction, survival rates were similar in patients with biventricular devices (74%) and those undergoing isolated left ventricular support (24%) (63% versus 45%, respectively; p = 0.2). Actuarial. survival estimates after transplantation were 78.7 +/- 6.3%, 73.4 +/- 6.9% and 62.6 +/- 8.3% at 1, 3 and 5 years, respectively. Conclusions. - Our experience validates the use of p-VAD as a primary device to support patients with cardiogenic shock. In contrast to short-term devices, p-VADs provide immediate ventricular unloading and pulsatile perfusion in a single procedure. Biventricular support should be used liberally in patients with end-organ dysfunction. (C) 2009 Elsevier Masson SAS. All rights reserved.