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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 578-586, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PM McCarthy, PM Portner, HG Tobler, VA Starnes, N Ramasamy and PE Oyer
At Stanford University, a Novacor left ventricular assist system (Baxter
Healthcare Corporation, Novacor Division, Oakland, Calif.) was placed as a
bridge to heart transplantation in 13 patients. During the hospitalization
preceding device implantation, all patients were receiving inotropic
support for biventricular failure, 11 had pulmonary edema, 6 had
life-threatening ventricular arrhythmias, 5 had liver dysfunction with
coagulopathy, and 2 had renal failure necessitating artificial support. The
mean cardiac index before implantation of the Novacor system was 1.5. All
survivors with the Novacor device had a dramatic increase in cardiac output
(mean cardiac index = 3.1). One patient with cardiac allograft rejection
died during implantation of the left ventricular assist system. Two
patients died of pulmonary sepsis and multiorgan failure after the device
was implanted. All patients who had the Novacor device implanted for more
than 7 days were able to walk and ride stationary bicycles while awaiting
transplantation. Ten patients (77%) underwent successful heart
transplantation after a mean of 18 days' support with the Novacor device.
One patient died of presumed sepsis 2 days after transplantation. Nine
patients (90%) are alive 4 months to 6 years after transplantation. In the
overall United States experience, 68 patients (as of May 1990) have had a
Novacor left ventricular assist device implanted. Five were still being
supported, 39 had received a transplant (62%), and 35 patients (90%)
survived the transplant hospitalization (1 died later). No instances of
device failure have occurred. Overall, the Novacor assist system provided
effective bridging to transplantation, with posttransplant survival similar
to results after routine transplantation. Modifications and improvements
based on this clinical experience have been made in the areas of patient
selection, techniques of operative placement, postoperative management, and
design of the assist system. Isolated left heart support with a fully
implantable left ventricular assist system will be offered as an
alternative to heart transplantation for selected patients by 1992.
ARTICLES
Clinical experience with the Novacor ventricular assist system. Bridge to transplantation and the transition to permanent application
Department of Cardiovascular Surgery, Stanford University, Calif.
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P. M. McCarthy, S. K. Schmitt, R. L. Vargo, S. Gordon, T. F. Keys, and R. E. Hobbs Implantable LVAD Infections: Implications for Permanent Use of the Device Ann. Thorac. Surg., January 1, 1996; 61(1): 359 - 365. [Abstract] [Full Text]
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R. Matsuwaka, H. Matsuda, M. Kaneko, Y. Miyamoto, T. Masai, T. Nakatani, E. Sasaki, and O. H. Frazier Overseas Transport of a Patient With an Extracorporeal Left Ventricular Assist Device Ann. Thorac. Surg., February 1, 1995; 59(2): 522 - 523. [Abstract] [Full Text]
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D. G. Pennington, L. R. McBride, and M. T. Swartz Implantation technique for the Novacor left ventricular assist system J. Thorac. Cardiovasc. Surg., October 1, 1994; 108(4): 604 - 608. [Abstract] [Full Text]
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A. Massiello, R. Kiraly, K. Butler, S. Himley, J.-F. Chen, and P. M. McCarthy The Cleveland Clinic-Nimbus total artificial heart: Design and in vitro function J. Thorac. Cardiovasc. Surg., September 1, 1994; 108(3): 412 - 419. [Abstract] [Full Text]
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P. M. McCarthy, K. Fukamachi, F. Fukumura, K. Muramoto, L. A. R. Golding, and H. Harasaki The Cleveland Clinic-Nimbus total artificial heart: In vivo hemodynamic performance in calves and preclinical studies J. Thorac. Cardiovasc. Surg., September 1, 1994; 108(3): 420 - 428. [Abstract] [Full Text]
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K. Fujita, G. E. McGrath, T. Morita, B. L. Robinson, J. W. Davis, and J. J. Morris The effects of left heart assist on right ventricular muscle mechanics and ventricular coupling in the injured heart J. Thorac. Cardiovasc. Surg., September 1, 1994; 108(3): 477 - 486. [Abstract] [Full Text]
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D. Loisance, P. H. Deleuze, J. P. Mazzucotelli, Y. Abe, P. Le Besnerais, and J. L. Dubois-Rande The initial experience with the wearable Baxter Novacor ventricular assist system J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 176 - 177. [Full Text]
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