Document Detail


Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure.
MedLine Citation:
PMID:  19664570     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 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 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.
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.
Authors:
Matthias Kirsch; Emmanuelle Vermes; Thibaud Damy; Kuniki Nakashima; Mélanie Sénéchal; Bernadette Boval; Ludovic Drouet; Daniel Loisance
Publication Detail:
Type:  Journal Article     Date:  2009-05-23
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  102     ISSN:  1875-2136     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:    2009 Jun-Jul
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-12-11     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  509-18     Citation Subset:  IM    
Affiliation:
Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil cedex, France. matthias.kirsch@hmn.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Equipment Design
Female
Heart Failure / complications,  mortality,  physiopathology,  therapy*
Heart Transplantation
Heart-Assist Devices* / adverse effects
Hospital Mortality
Humans
Intensive Care
Kaplan-Meier Estimate
Male
Middle Aged
Patient Admission
Retrospective Studies
Risk Assessment
Shock, Cardiogenic / etiology,  mortality,  physiopathology,  therapy*
Time Factors
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):473-5   [PMID:  19664566 ]

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