Community support of patients with a left ventricular assist device: The Toronto General Hospital experience

BACKGROUND: Implantation of a left ventricular assist device (LVAD) is an acceptable therapy for patients with advanced heart failure. LVADs may be used as a bridge to recovery, a bridge to transplantation or as destination therapy. Although the morbidity rate of individuals on device support remains high, experience suggests that patients who are discharged home have satisfactory outcomes during support and following heart transplantation. METHODS: A retrospective review of 24 patients implanted with an LVAD between October 2001 and December 2006 was performed. Nineteen patients received a device as a bridge to transplantation and five received a device as destination therapy. Postoperative follow-up was performed routinely in the heart function/LVAD clinic at the Toronto General Hospital (Toronto, Ontario) and all adverse events were recorded. RESULTS: The majority of patients were men, with a mean age of 44 years and a diagnosis of dilated cardiomyopathy (62%). Seventeen patients (71%) were discharged home on support; one died, 14 were transplanted, one was explanted and one patient remains on support in the community. Post-transplant survival was 93% in patients discharged home compared with 40% transplanted during their hospital stay. Outpatients spent 56% of their overall support time at home, with only 12 readmissions totalling 120 patient days. CONCLUSIONS: LVAD patients can be safely managed in the community. Patients who are discharged home experience better outcomes in both pre- and post-transplant survival. Successful outpatient management provides a strong foundation for the establishment of destination therapy within mechanical circulatory support programs in Canada.