Ann Thorac Surg 2005;80:2421
© 2005 The Society of Thoracic Surgeons
Correspondence
Longest Time of Support by the Novacor Left Ventricular Assist Device Without Pump Exchange
Evgenij V. Potapov, MD,
Yuguo Weng, MD, PhD,
Thorsten Drews, MD,
Michael Jurmann, MD,
Roland Hetzer, MD, PhD
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, 13353 Germany
(Email: potapov{at}dhzb.de).
To the Editor:
Left ventricular assist devices (LVADs) have been successfully used as a bridge to heart transplantation. The Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial has shown the superiority of LVAD therapy in comparison with medical treatment in the survival of nontransplant candidates with end-stage heart failure [1]. However, crucial questions for definitive therapy, such as the feasible duration and long-term quality of life on the LVAD are still unanswered.
A 56-year-old woman with a hypophysis tumor leading to acromegaly and cardiomegaly with dilative cardiomyopathy was admitted in cardiogenic shock, and a Novacor LVAD (World Heart Inc, Oakland, CA) was urgently implanted. The postoperative course was uneventful, and she was discharged home. Because the tumor was benign, heart transplantation was considered to be an option, but the patient preferred to stay on the LVAD. During support, radiation of the tumor was performed. As of March 10, 2005, the patient has been on the device for 4 years and 10 months, which is the longest LVAD support time without pump exchange worldwide. Routine monitoring of the wear of the pump bearings by measurement of the solenoid tuning (gain) and energy changes (spring latch current) as recommended by the manufacturer [2] indicated abnormal device function. The pump was electively replaced using femoro-femoral cardiopulmonary bypass without redo sternotomy. The procedure was uneventful, and the patient was discharged home.
Despite marked progress in pharmacologic therapy and mechanical circulatory support, heart transplantation remains the preferred option for patients with end-stage heart failure. The shortage of donor organs and the growing numbers of older patients are stimulating the development of assist systems suitable for definitive therapy. The development of new devices focuses on greater reliability and durability, on small size, and on transcutaneous energy transfer [3, 4]. Optimal device and patient selection, and finding the optimal time for implantation are the main challenges to be addressed to maximize the benefit for patients with end-stage heart failure, and these issues are now being investigated in a number of clinical trials.
There are now several patients with LVADs approaching such long assist periods. The Novacor (World Heart Inc) register contains 6 patients supported for over 4 years, 5 of whom required pump exchange. A support time of nearly 4 years has been reported for HeartMate I [5] and nearly 5 years for Jarvik 2000 (personal communication with the patient). Our experience includes 3 patients supported by a Novacor LVAD (World Heart Inc), and 2 patients with Berlin Heart Excor (Berlin Heart AG, Berlin, Germany) for over 4 years.
This cumulative experience shows that definitive LVAD therapy can be continued with good quality of life for over 4 years, and therefore it is a good alternative for nontransplant candidates. We expect it to gain an important place in the treatment of end-stage heart failure.
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References
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- Rose EA, Gelijins AC, Moskowitz AJ, et al. Long term use of a left ventricular assist device for end stage heart failure N Engl J Med 2001;345:1435-1443.[Abstract/Free Full Text]
- Wheeldon DR, LaForge DH, Lee J, Jansen PG, Jassawalla JS, Portner PM. Novacor left ventricular assist system long-term performancecomparison of clinical experience with demonstrated in vitro reliability. ASAIO J 2002;48(5):546-551.[Medline]
- Frazier OH, Myers TJ, Westaby S, Gregoric ID. Use of the Jarvik 2000 left ventricular assist system as a bridge to heart transplantation or as destination therapy for patients with chronic heart failure Ann Surg 2003;237(5):631-637.[Medline]
- Hetzer R, Weng Y, Potapov E, et al. First experiences with a novel magnetically suspended axial flow left ventricular assist device Eur J Cardiothorac Surg 2004;25(6):964-970.[Abstract/Free Full Text]
- REMATCH InvestigatorsStevenson LW, Miller LW, Desvigne-Nickens P. Left ventricular assist device as destination for patients undergoing intravenous inotropic therapya subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). Circulation 2004;110(8):975-981.[Abstract/Free Full Text]
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