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Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
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2000 (English)In: Journal of cardiothoracic and vascular anesthesia, ISSN 1053-0770, Vol. 14, no 4, 438-443 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center.

Design: A prospective study from February 1993 to June 1999.

Setting: A university hospital.

Participants: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3).

Interventions: The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period.

Measurements and Main Results: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended.

Conclusions: The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.

Place, publisher, year, edition, pages
2000. Vol. 14, no 4, 438-443 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13610DOI: 10.1053/jcan.2000.7943OAI: diva2:21053
Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2013-09-26
In thesis
1. Management of patients treated with left ventricular assist devices: A clinical and experimental study
Open this publication in new window or tab >>Management of patients treated with left ventricular assist devices: A clinical and experimental study
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described.

An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a non-transplanting center. A multidisciplinary approach was enabled thanks to the organization of our Heart Center and due the close collaboration with our transplant center at Lund University. As one of the first centers in Europe, we established a well-functioning program with good results. Nine out of 10 of the bridge patients, with treatment times varying between 53 to 873 days, survived pump treatment and were eventually transplanted. The device proved to be powerful enough to support the failing heart and enable rehabilitation of the patients. Outpatient management became simpler when using the electrical device with belt-worn batteries. The uncertain durability and the high risk of device-related complications are shortcomings that limit its potential for more permanent treatment of heart failure.

A new generation of small implantable axial blood flow pumps has therefore been developed. The principles of these pumps are based on the first generation axial flow pumps evaluated in this thesis. After several years of basic research and experimental studies, the first human implants have been performed. In the thesis, the hemodynamic effects of such a novel axial flow pump have been evaluated in an acute heart failure model. This technology holds great promise, both as a bridge to heart transplantation, and as a permanent circulatory support system.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. 79 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 677
postcardiotomy heart failure, perioperative monitoring, coronary artery bypass, heart-assist devices, heart failure, congestive, ventricular dysfunction
National Category
urn:nbn:se:liu:diva-5151 (URN)91-7219-969-5 (ISBN)
Public defence
2001-05-21, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 00:00 (English)
On the day of the public defence the status of the article IV was: Submitted for publication.Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2012-01-24Bibliographically approved

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Peterzén, BengtGranfeldt, HansNylander, EvaDahlström, UlfRuthberg, HansCasimir Ahn, Henrik
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Department of Medicine and Health SciencesFaculty of Health SciencesDepartment of Thoracic and Vascular SurgeryThoracic SurgeryClinical Physiology Department of Clinical PhysiologyCardiology
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