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J Thorac Cardiovasc Surg 1999;118:769-770
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

A fatal mechanical disorder of the TCI HeartMate left ventricular assist system

Yukihiro Bonkohara, MD, Kazutomo Minami, MD, Latif Arusoglu, MD, Aly El-Banayosy, MD, Oliver Fey, Peter Sarnowski, Reiner Körfer, MD

Department of Thoracic and Cardiovascular Surgery
Heart Center North Rhine–Westphalia
Ruhr University of Bochum
Bad Oeynhausen, Germany

To the Editor:

The HeartMate vented electric (VE) left ventricular assist system (LVAS) (TCI; Thermo Cardiosystems Inc, Woburn, Mass) has been used in more than 1400 patients worldwide and in 42 patients in our hospital since November 1995. We experienced a case of fatal mechanical disorder with this device, which required an emergency exchange of the LVAS. The patient was a 34-year-old man who had undergone implantation of the HeartMate VE LVAS because of dilative cardiomyopathy more than 1 year earlier. He was referred to us twice for problems with a cable. In both events, the LVAS worked normally and the patient’s condition was stable. The cable was thoroughly examined and repaired by a technician from TCI. Four days after the second cable repair, the red alarm suddenly warned at home. The manual mechanical pumping with the hand pump was immediately initiated by the patient himself, and he was transferred to our hospital urgently by helicopter. During the transport his condition worsened and he needed to be intubated. This emergency occurred 380 days after the LVAS implantation. The LVAS could still work with the pneumatic system, so that his hemodynamic condition was well controlled with dopamine perfusion. The problem with the LVAS was studied by a technician from TCI. Because dried bloodlike material was observed in the hand pump and the stroke volume limiter connecting tube, we suspected a rupture of the drive line or the diaphragm separating the blood pump chamber from the motor chamber in the LVAS. We exchanged the LVAS through the incision in the abdominal pocket with cardiopulmonary bypass established through the femoral artery and vein. The postoperative course was excellent. He was discharged to his home on postoperative day 24 and is now waiting for heart transplantation. The explanted pump was carefully examined. The motor chamber was filled with clotted dried blood, which prevented the motor/cam assembly from working (Fig 1).However, by macroscopic observation we could not find any tears or holes in the diaphragm. The pump was sent to TCI for precise inspection. TCI’s technicians detected small tears at the rim of the diaphragm, which might have been caused by mechanical fatigue.



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  		Fig. 1. Clotted blood was seen in the whole LVAS motor chamber, which prevented the pump from working.

 
The TCI HeartMate LVAS is one of the most reliable systems in the world.Go Go 1,2 We have implanted the pneumatic HeartMate LVAS in 14 patients since April 1994 and the VE HeartMate LVAS in 28 patients since November 1995.Go 3 A similar device disorder with the VE HeartMate LVAS was reported by Piccione and colleaguesGo 4 in 1998. They showed, as in this report, that the motor chamber filled with clotted blood. However, they could not find any perforation on the drive line, and they did not refer to the diaphragm. To our knowledge, this is the first report of a disorder of the diaphragm in the pump with the VE HeartMate LVAS. The support time of this patient was 380 days. This long support time might be one of the reasons for this defect.

References

  1. Oz MC, Argenziano M, Catanese KA, Gardocki MT, Goldstein DJ, Ashton RC, et al. Bridge experience with long-term implantable left ventricular assist devices. Circulation 1997;95:1844-52.[Abstract/Free Full Text]
  2. Massad MG, McCarthy PM. Will permanent LVADs be better than heart transplantation? Eur J Cardiothorac Surg 1997;11 (Suppl):S11-7.
  3. El-Banayosy A, Minami K, Arusoglu L, Fey O, Kitzner L, Hartmann D, et al. Long-term mechanical circulatory support. Thorac Cardiovasc Surg 1997;45:127-30.[Medline]
  4. Piccione W, Kao WG, Mattea A, Rodriguez ER, Trohman RG. Failure of an implantable left ventricular assit device: a distinctive electrocardiographic pattern before malfunction. J Thorac Cardiovasc Surg 1998;115:1376-8.[Free Full Text]



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