Mechanical circulatory supportIncidence and clinical management of life-threatening left ventricular assist device failure
Section snippets
Patients and methods
A total of 102 patients were studied, including 82 Thoratec TCI/HeartMate (54 vented electric [VE0], 8 XVEs and 20 implantable pneumatic [IP] devices) and 20 Thoratec PVAD devices, which were implanted at our institution since 1995. Patient records were reviewed and any incidence of major device failure studied. Major device failure was defined as the need for emergency pump replacement or the need for pneumatic pump actuation. The 54 VE devices were implanted in 45 men and 9 women, mean age
Results
For the whole group, the cumulative support period was 46.3 patient-years. Of the 102 patients, 28 (27.5%) were supported for >200 days. The longest freedom from device failure for an implant was 748 days in a patient successfully bridged to recovery. The total cumulative probability of device failure was 6% at 6 months, 12% at 1 year, 27% at 18 months and 64% at 2 years (Figure 2). Major device failure occurred in a total of 8 (7.8%) patients. Six failures occurred in HeartMate I VEs, 1 in an
Discussion
This study has defined the rate and mode of mechanical failure of left ventricular assist devices and described the methods for dealing with them in a homogeneous series of patients encountered at 1 center over a period of 9 years. In this study the cumulative probability of device failure was 6% at 6 months, 12% at 1 year, 27% at 18 months and 64% at 2 years, with major device failure occurring in a total of 7.8% of patients. Life-threatening mechanical pump failure was therefore not uncommon
Conclusions
Life-threatening mechanical pump failure is not uncommon, but can be managed successfully in most patients. Although designed for short-term use, these devices can be used for longer periods if necessary, although the incidence of device failure does increase with time. Newer devices being developed are likely to have better reliability and durability. It is hoped that a thorough understanding of the mode of failure and its management coupled with improvements in design and manufacture will
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