Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure.
Details
Serval ID
serval:BIB_0331E076F1EB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure.
Journal
Archives of cardiovascular diseases
ISSN
1875-2136 (Print)
ISSN-L
1875-2128
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
102
Number
6-7
Pages
509-518
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal ventricular assist device (p-VAD).
We did a retrospective analysis of demographics, clinical characteristics and survival of patients assisted with a Thoratec p-VAD.
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 micromol/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.
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.
To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal ventricular assist device (p-VAD).
We did a retrospective analysis of demographics, clinical characteristics and survival of patients assisted with a Thoratec p-VAD.
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 micromol/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.
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.
Keywords
Adolescent, Adult, Critical Care, Equipment Design, Female, Heart Failure/complications, Heart Failure/mortality, Heart Failure/physiopathology, Heart Failure/therapy, Heart Transplantation, Heart-Assist Devices/adverse effects, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Patient Admission, Retrospective Studies, Risk Assessment, Shock, Cardiogenic/etiology, Shock, Cardiogenic/mortality, Shock, Cardiogenic/physiopathology, Shock, Cardiogenic/therapy, Time Factors, Treatment Outcome, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
29/03/2019 7:09
Last modification date
20/08/2019 12:25