BACKGROUND: Mechanical circulatory support systems (MCSS) have been available in Canada since 1986. Accepted indications include bridging to transplantation or recovery. The present study reviewed the results following MCSS implantation at the Montreal Heart Institute (Montreal, Quebec). METHODS: From September 1987 to September 2006, 43 MCSS were implanted (32 Thoratec [Thoratec Corporation, USA], nine CardioWest TAH [SynCardia Systems Inc, USA], two Novacor [WorldHeart Corporation, Canada]) in 43 patients (mean [+/- SD] age 44+/-13 years; range 19 to 64 years). Indications for implantation included cardiogenic shock due to ischemic (n=19), viral (n=10) or other types of cardiomyopathies (n=14). RESULTS: The mean ejection fraction before implantation was 17.6+/-6.5% (range 10% to 45%). Before MCSS implantation, most patients showed signs of end-organ failure, including mechanical ventilation (77%), central venous pressure higher than 16 mmHg (44%), oliguria (35%) and hepatic dysfunction (19%). The mean duration of MCSS support was 22.8+/-32.8 days (range one to 158 days). Survival to transplantation or recovery was 74%. Only one patient was successfully bridged to recovery. Complications were common during MCSS support. They included reexploration for bleeding (47%), respiratory failure (44%), renal failure requiring temporary dialysis (40%), infection (33%) and neurological events (16%). Only one patient had device failure. In patients successfully bridged to transplantation, early actuarial survival (one month) following transplantation averaged 71+/-8% and was 57+/-9% at one year. CONCLUSION: MCSS support with a left ventricular assist device or a total artificial heart provides an effective means of bridging terminally ill patients to transplantation or recovery. Early survival after transplantation shows satisfactory results. However, these results come at the expense of frequent device-related complications, and device failure remains a constant threat.
BACKGROUND: Mechanical circulatory support systems (MCSS) have been available in Canada since 1986. Accepted indications include bridging to transplantation or recovery. The present study reviewed the results following MCSS implantation at the Montreal Heart Institute (Montreal, Quebec). METHODS: From September 1987 to September 2006, 43 MCSS were implanted (32 Thoratec [Thoratec Corporation, USA], nine CardioWest TAH [SynCardia Systems Inc, USA], two Novacor [WorldHeart Corporation, Canada]) in 43 patients (mean [+/- SD] age 44+/-13 years; range 19 to 64 years). Indications for implantation included cardiogenic shock due to ischemic (n=19), viral (n=10) or other types of cardiomyopathies (n=14). RESULTS: The mean ejection fraction before implantation was 17.6+/-6.5% (range 10% to 45%). Before MCSS implantation, most patients showed signs of end-organ failure, including mechanical ventilation (77%), central venous pressure higher than 16 mmHg (44%), oliguria (35%) and hepatic dysfunction (19%). The mean duration of MCSS support was 22.8+/-32.8 days (range one to 158 days). Survival to transplantation or recovery was 74%. Only one patient was successfully bridged to recovery. Complications were common during MCSS support. They included reexploration for bleeding (47%), respiratory failure (44%), renal failure requiring temporary dialysis (40%), infection (33%) and neurological events (16%). Only one patient had device failure. In patients successfully bridged to transplantation, early actuarial survival (one month) following transplantation averaged 71+/-8% and was 57+/-9% at one year. CONCLUSION: MCSS support with a left ventricular assist device or a total artificial heart provides an effective means of bridging terminally ill patients to transplantation or recovery. Early survival after transplantation shows satisfactory results. However, these results come at the expense of frequent device-related complications, and device failure remains a constant threat.
Authors: Heather Ross; Paul Hendry; Anne Dipchand; Nadia Giannetti; Greg Hirsch; Debra Isaac; Narendra Singh; Lori West; Michel White; Andrew Ignaszewski; Anton Maria Chung; Lynn Straatman; Dennis Modry; Wayne Tymchak; Jeffrey Burton; Wayne Warnica; Jose Eduardo Azevedo; William Kostuk; Alan Menkis; Peter Pflugfelder; Mackenzie Quantz; Ross Davies; Haissam Haddad; Roy Masters; Robert Cusimano; Diego Delgado; Chris Feindel; Vivek Rao; Marcelo Cantarovich; Renzo Cecere; Michel Carrier; Michel Pellerin; Daniel Doyle; Marie-Hélène LeBlanc; Jonathan Howlett; Henry Haddad Journal: Can J Cardiol Date: 2003-05 Impact factor: 5.223
Authors: Tofy Mussivand; Michel Carrier; Ray C J Chiu; Ross A Davies; Diego H Delgado; Mario C Deng; Haissam Haddad; Paul J Hendry; Wilbert J Keon; Arvind Koshal; Roy G Masters; Thierry Mesana; Vivek Rao Journal: Artif Organs Date: 2004-03 Impact factor: 3.094
Authors: Ismaïl El-Hamamsy; Michel White; Michel Pellerin; Philippe Demers; Denis Bouchard; Tack Ki Leung; Louis P Perrault; Michel Carrier Journal: Can J Cardiol Date: 2006-05-01 Impact factor: 5.223
Authors: B C Sun; K A Catanese; T B Spanier; M R Flannery; M T Gardocki; L S Marcus; H R Levin; E A Rose; M C Oz Journal: Ann Thorac Surg Date: 1999-08 Impact factor: 4.330
Authors: Michel Carrier; Louis P Perrault; Denis Bouchard; Michel Pellerin; Normand Racine; Michel White; Guy Pelletier Journal: Can J Cardiol Date: 2004-04 Impact factor: 5.223
Authors: M C Oz; D J Goldstein; P Pepino; A D Weinberg; S M Thompson; K A Catanese; R L Vargo; P M McCarthy; E A Rose; H R Levin Journal: Circulation Date: 1995-11-01 Impact factor: 29.690