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J Thorac Cardiovasc Surg 2006;131:1211-1212
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Left ventricular assist device in heart failure

Omer Ashraf, MBBS

Aga Khan University, Karachi, Pakistan

To the Editor:

I read with great interest the article by Nicholas C. Dang and colleagues, wherein they report their experience with left ventricular assist device (LVAD) in patients with chronic congestive heart failure. 1 Go There are various mechanical circulatory devices employed currently as a bridge to transplantation. The authors report their experience with the HeartMate (Thoratec Corp, Pleasanton, CA) device; however, the type of device engaged is not mentioned. It is pertinent to note that of HeartMate LVADs, the single-lead vented electrical devices have been linked with the best posttransplant survival rates. 2 Go

Even as vigilance for the predictive factors 1 Go will help in patient selection, improved clinical outcome should also be sought by careful timing of transplantation following LVAD insertion. By instituting patient support and rehabilitation for at least a month following the implantation, significant normalization of end-organ function and improvement in physiologic status may be achieved to improve survival following the transplant. 3 Go

A possible scoring system for better selection of patient criteria is sought. In this context the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system, a multiparameter, physiology-based predictor of outcome, might be helpful. It can aid in both selection and timing of LVAD implantation, particularly in patients not meeting normal hemodynamic criteria for LVAD usage. 4 Go

Development of right ventricular failure often causes poor results in patients with LVADs. It is important to take into consideration the predictive factors including the need for circulatory support, female gender, and nonischemic etiology, along with the hemodynamic alterations including low pulmonary artery pressure and low right ventricle stroke work index, that might indicate poor right ventricular outcome. 5 Go Careful observation of the above would assist both in patient selection and clinical handling of isolated LVAD implants.


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  1. Dang NC, Topkara VK, Kim BT, Mercando ML, Kay J, Naka Y. Clinical outcomes in patients with chronic congestive heart failure who undergo left ventricular assist device implantation. J Thorac Cardiovasc Surg 2005;130:1302-1309.[Abstract/Free Full Text]
  2. Morgan JA, John R, Rao V, Weinberg AD, Lee BJ, Mazzeo PA, et al. Bridging to transplant with the HeartMate left ventricular assist device. The Columbia Presbyterian 12-year experience. J Thorac Cardiovasc Surg 2004;127:1309-1316.[Abstract/Free Full Text]
  3. Gammie JS, Edwards LB, Griffith BP, Pierson 3rd RN, Tsao L. Optimal timing of cardiac transplantation after ventricular assist device implantation. J Thorac Cardiovasc Surg 2004;127:1789-1799.[Abstract/Free Full Text]
  4. Gracin N, Johnson MR, Spokas D, Allen J, Bartlett L, Piccione W, et al. The use of APACHE II scores to select candidates for left ventricular assist device placement. Acute Physiology and Chronic Health Evaluation. J Heart Lung Transplant 1998;17:1017-1023.[Medline]
  5. Ochiai Y, McCarthy PM, Smedira NG, Banbury MK, Navia JL, Feng J, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion. analysis of 245 patients. Circulation 2002;106:I198-I202.

Related Article

Reply to the Editor
Nicholas C. Dang and Yoshifumi Naka
J. Thorac. Cardiovasc. Surg. 2006 131: 1212. [Extract] [Full Text] [PDF]




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