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Ann Thorac Surg 2000;70:66
© 2000 The Society of Thoracic Surgeons

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Invited commentary

Invited commentary

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The best form of advanced support for patients with ventricular failure depends on many factors. These include institutional experience with available technologies and individual patient characteristics such as likelihood of recovery, expected duration of support and candidacy for heart transplantation or permanent ventricular device insertion.

The BVS 5000i ventricular assist device is the clear leader on record today for use as a short–term circulatory support device. Average use for over 3,500 implants has been 6.6 days. It is FDA approved for bridge to recovery. It is relatively inexpensive, simple to use, and has a strong clinical support team provided by Abiomed.

The thrombogenic nature of the current device can be combated with vigorous careful anticoagulation but bleeding can be problematic. Thrombosing devices can be easily exchanged for new ones at the bedside.

Recent improvements include reduced cannula size, ventricular apical cannula, and a new portable drive console which provides vacuum assisted diastolic filling. These changes seem to be harbingers of things to come. They are all designed to continue to improve pre–load and after–load performance, to increase flow as well as patient mobility and hopefully reduce thrombogenicity and cost.

Using widely available technology, successful short–term circulatory support can often be provided by percutaneously placing peripheral venoarterial bypass. Supported patients can be evaluated for candidacy for bridge transplant or permanent device insertion without being subjected to major surgery and excessive bleeding which can compromise long–term results by introducing threatening immunological and infectious factors.

UCLA has clearly demonstrated that the BVS 5000i can be used as a bridge to transplant but that application is solely the result of the ready availability of cardiac donors (Status I waiting time–24 days) and does not reflect the plight of most transplant centers in the United States where waiting times (Status 1A–42 days, Status 1B–92 days), are unfortunately much longer, making this short–term pump less useful in general as a bridge to transplantation.

Related Article

Mechanical assist strategy using the BVS 5000i for patients with heart failure

Daniel Marelli, Hillel Laks, Daniel Fazio, Michele A. Hamilton, Gregg C. Fonarow, Deborah A. Meehan, and Jaime D. Moriguchi
Ann. Thorac. Surg. 2000 70: 59-66. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Walter P. Dembitsky Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dembitsky, W. P. Search for Related Content PubMed Articles by Dembitsky, W. P. Related Collections Related Article