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(Circulation. 2005;112:I-65 – I-72.)
© 2005 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Biventricular Assist Device Utilization for Patients with Morbid Congestive Heart Failure

A Justifiable Strategy

Hiroyuki Tsukui, MD; Jeffrey J. Teuteberg, MD; Srinivas Murali, MG; Dennis M. McNamara, MD; Julianne R. Buchanan, MS; Stephen Winowich, BSChE; Eileen Stanford, BSN, CRNP; Michael A. Mathier, MD; Linda M. Cadaret, MD; Robert L. Kormos, MD, FAHA, FRCS

From the Division of Cardiothoracic Surgery and McGowan Institute for Regenerative Medicine (H.T., J.R.B., S.W., E.S., R.L.K.), and the Division of Cardiology (J.J.T., S.M., D.M.M., M.A.M., L.M.C.), University of Pittsburgh Medical Center, Pittsburgh, Penn.

Correspondence to Robert L. Kormos, MD, Division of Cardiothoracic Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Suite C-700, 200 Lothrop St, Pittsburgh, PA 15213. E-mail kormosrl{at}upmc.edu

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.

Key Words: biventricular assist device • cardiomyopathy • heart failure