Most patients had organ recovery with left ventricular assist system support, and a considerable number of patients in both groups underwent transplantation. However, both devices need revision to address the current problems, that is, thromboembolism for the Novacor device and infection and reliability for the HeartMate device.
Between September 1989 and June 1999, 228 patients were supported with a ventricular assist device as a bridge to heart transplantation. In this study, the results of implantation were evaluated in patients supported with one type of device, including 85 supported with a Thoratec, 61 with a Novacor, and 37 with a HeartMate. The mean support time was 49, 148, and 124 days, respectively. Successful transplantation and weaning rates were 64. 7% with Thoratec, 59.0% with Novacor, and 62.0% with HeartMate. Cerebral embolism and drive-line and pocket infection were major causes of postoperative morbidity and mortality. We recommended that a Thoratec system be employed as a bridge to heart transplantation for patients with biventricular heart failure, and that a Novacor or HeartMate system be implanted in patients requiring a long-term circulatory support.
Heparin-induced thrombocytopenia was more prevalent in patients receiving mechanical circulatory support than in other cardiac patients. Frequent antibody screening is recommended due to the increased risk of thromboembolism. Heparin alternatives should be subjected to clinical trials in these high-risk patients.
The Thoratec ventricular assist device has proved to be a reliable device for bridge to transplantation and postcardiotomy support. Further studies are required on patient selection and on patient and device management to reduce the incidence of complications in these patient populations.
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