Use of Left Ventricular Assist Device ( H eart M ate II ): A S ingapore Experience

• Published in: Artificial organs 2014-07, Vol.38 (7), p.543-548
• Main Authors: Lim, Choon Pin, Sivathasan, Cumaraswamy, Tan, Teing Ee, Lim, Chong Hee, Kerk, Ka Lee, Sim, David Kheng Leng
• Format: Article
• Language: English
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.12247

Recent advances in medical and device therapies in heart failure have improved the survival of patients with heart failure. However, due to the limited availability of suitable heart donors, left ventricular assist devices ( LVAD s) have become an important tool as a bridge‐to‐heart transplantation for patients with refractory heart failure in S ingapore. We report our experience with the H eart M ate II ( HMII ) LVAD (Thoratec Corporation, Pleasanton, CA, USA) as a bridge‐to‐heart transplant in our center from 2009 to 2012. This was a retrospective review of 23 consecutive patients who underwent HMII LVAD implantation in our center between M ay 2009 and D ecember 2012. All patients were classified as I nteragency R egistry for M echanically A ssisted C irculatory S upport ( INTERMACS ) levels 1 to 3 and underwent LVAD implantation as a bridge‐to‐heart transplant. There were 17 male and 6 female patients. The mean age was 43.6 years old (range 14 to 64). The etiologies of heart failure included ischemic heart disease [8], idiopathic dilated cardiomyopathy [11], viral myocarditis [2], and chemotherapy‐induced cardiomyopathy [2]. Nine patients were INTERMACS level 1, 12 patients level 2, and two patients level 3. All patients successfully underwent HMII LVAD implantation. There was no mortality within the first 30 postoperative days. Postoperative complications included stroke with full neurological recovery (21.7%), mediastinal infection (21.7%), cardiac tamponade or mediastinal collection requiring reopening of the chest (39.1%), cardiac arrhythmia (13.0%), and pump thrombosis with pump replacement (4.3%). All patients were discharged from hospital after LVAD implantation. Three patients experienced driveline infections during outpatient follow‐up. There were 19 readmissions due to the following conditions: sub‐therapeutic anticoagulation (13.0%), gastrointestinal bleeding (13.0%), suspected pump thrombosis (13.0%), transient ischemic attack (8.7%), arrhythmia (8.7%), congestive cardiac failure due to severe aortic regurgitation (8.7%), right ventricular failure (4.3%), rhabdomyolysis (4.3%), and hematuria (4.3%). Post‐ LVAD implantation, 20 patients were functionally New York Heart Association ( NYHA ) class I, while 3 reported NYHA III symptoms. Three patients were successfully bridged to heart transplantation. One patient was successfully explanted 11 months after LVAD implantation. There were two mortalities during the follow‐up period. The average dur