J Thorac Cardiovasc Surg 2006;132:210
© 2006 The American Association for Thoracic Surgery
More pumps—more questions
E.V. Potapov, MD,
R. Hetzer, MD, PhD
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
(Email: potapov{at}dhzb.de).
To the Editor:
We would like to congratulate Wilhelm and colleagues
1
on their outstanding results concerning long-term survival after the implantation of axial flow left ventricular assist devices (LVADs). Since the worldwide first implantation of the axial flow pump in our institution on November 13, 1998,
2
followed by implantations in Vienna 1 week later,
3
these pumps have increasingly gained acceptance. Long-term LVAD support not only enables patients to be bridged to heart transplantation or recovery but also opens up the opportunity to prolong high-quality life for nontransplant candidates. The article presented also shows that long-term nonpulsatile or less-pulsatile blood flow is not detrimental for the function of the end organs. Our experience with 44 patients who were supported with rotary blood pumps for more than 200 days accords with the results presented by the authors. However, good long-term results can also be achieved with pulsatile systems. Of a total of 110 patients supported with an LVAD for longer than 200 days in our institution, 66 had pulsatile devices. Of these, 3 patients were supported for more than 4 years with the Novacor LVAS and 2 with the BerlinHeart Excor.
4
During long-term support, appropriate anticoagulation plays a key role for the survival and complication rates. As anticoagulative medication with the rotary pumps, we now administer phenprocoumon with a target international normalized ratio of 2.5, aspirin, and, in patients supported with axial flow pumps, additional clopidogrel according to platelet aggregation tests, taking polymorphism of the platelet GP IIb/IIIa receptors into consideration.
5
In our opinion the aspirin dose should not exceed 100 mg/d.
We would be interested in the authors' current anticoagulation protocols and whether they used different regimens in patients with different rotary blood pumps. Second, based on the experience gained in Münster, are there any preferences of pump type for destination therapy?
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References
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- Wilhelm MJ, Hammel D, Schmid C, Rhode A, Kaan T, Rothenburger M, et al. Long-term support of 9 patients with the DeBakey VAD for more than 200 days. J Thorac Cardiovasc Surg 2005;130:1122-1129.[Abstract/Free Full Text]
- Potapov EV, Loebe M, Nasseri BA, Sinawski H, Koster A, Kuppe H, et al. Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device. Circulation 2000;102(suppl III):III183-III187.[Medline]
- Wieselthaler GM, Schima H, Lassnigg A, Pacher R, Ovsenk T, Laufer G, et al. The DeBakey VAD axial flow pump. first clinical experience with a new generation of implantable, nonpulsatile blood pumps for long-term support prior to transplantation. Wien Klin Wochenschr 1999;111:629-635.[Medline]
- Potapov E, Jurmann M, Drews T, Pasic M, Loebe M, Weng Y, et al. Patients supported for over four years with left ventricular assist devices. Eur J Heart Fail 2006In press.
- Potapov EV, Ignatenko S, Nasseri BA, Loebe M, Harke C, Bettmann M, et al. Clinical significance of PlA polymorphism of platelet GP IIb/IIIa receptors during long-term VAD support. Ann Thorac Surg 2004;77:869-874.[Abstract/Free Full Text]
Related Article
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Reply to the Editor:
- Markus J. Wilhelm, Christof Schmid, and Hans H. Scheld
J. Thorac. Cardiovasc. Surg. 2006 132: 210-211.
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