The european experience of Novacor left ventricular assist (LVAS) therapy as a bridge to transplant: A retrospective multi-centre study

A. El-Banayosy, M. Deng, D. Y. Loisance, H. Vetter, E. Gronda, Matthias Loebe, M. Vigano

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective: Artificial heart devices have suffered from a negative press based on the early Jarvik experience of the 1980s. This is in stark contrast to realities of current left ventricular assist (LVAS) therapy. The Novacor N100 PC wearable left ventricular assist system (LVAS) was introduced in Europe in late 1993. This system allows implanted recipients to be completely autonomous with the system controlled by a small computer and powered by rechargeable batteries. This report represents the initial European experience with the Novacor LVAS. Methods: Since the system was introduced with regulatory approval as a commercial product, clinicians were not bound by the constraints of a study protocol and only minimal data were collected. This report presents the results of a retrospective study of 118 consecutive patients who had the LVAS implanted as a bridge to transplant, in 19 centres over the three year period ending in November 1996. Results: Mortality and morbidity varied widely between centres. The median implant time was 115 days (0-585 days) and 33% of patients returned home, supported by the LVAS. The overall survival on LVAS was 64%. The major causes of death were infection (14%) and MOF (6%). There were no significant device or system failures despite a cumulative patient experience of 24.8 years outside of a hospital environment. Patient selection and management varied greatly between centres and this was reflected in disparate outcomes. Conclusions: Optimal selection and management of LVAS patients has still to be established. While the data available for this report lacked the detail necessary to demonstrate direct causal relationships between selection and management, it was clear from the inter-centre differences that these two factors have a major impact on outcomes. This early experience has directed attention towards improved management regimes. Given the results obtained from the best centres and the ability to discharge patients to lead near-normal lives in the community, the authors believe that the Novacor LVAS now offers a real therapeutic alternative for selected end-stage heart failure patients for whom a donor heart is unavailable or who are unsuitable for transplantation.

Original languageEnglish (US)
Pages (from-to)835-841
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume15
Issue number6
DOIs
StatePublished - Jun 1 1999
Externally publishedYes

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Transplants
Artificial Heart
Therapeutics
Equipment and Supplies
Patient Discharge
Patient Selection
Cause of Death
Heart Failure
Retrospective Studies
Transplantation
Tissue Donors
Morbidity
Survival
Mortality
Infection

Keywords

  • Bridge to transplant
  • Left ventricular assist therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The european experience of Novacor left ventricular assist (LVAS) therapy as a bridge to transplant : A retrospective multi-centre study. / El-Banayosy, A.; Deng, M.; Loisance, D. Y.; Vetter, H.; Gronda, E.; Loebe, Matthias; Vigano, M.

In: European Journal of Cardio-thoracic Surgery, Vol. 15, No. 6, 01.06.1999, p. 835-841.

Research output: Contribution to journalArticle

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abstract = "Objective: Artificial heart devices have suffered from a negative press based on the early Jarvik experience of the 1980s. This is in stark contrast to realities of current left ventricular assist (LVAS) therapy. The Novacor N100 PC wearable left ventricular assist system (LVAS) was introduced in Europe in late 1993. This system allows implanted recipients to be completely autonomous with the system controlled by a small computer and powered by rechargeable batteries. This report represents the initial European experience with the Novacor LVAS. Methods: Since the system was introduced with regulatory approval as a commercial product, clinicians were not bound by the constraints of a study protocol and only minimal data were collected. This report presents the results of a retrospective study of 118 consecutive patients who had the LVAS implanted as a bridge to transplant, in 19 centres over the three year period ending in November 1996. Results: Mortality and morbidity varied widely between centres. The median implant time was 115 days (0-585 days) and 33{\%} of patients returned home, supported by the LVAS. The overall survival on LVAS was 64{\%}. The major causes of death were infection (14{\%}) and MOF (6{\%}). There were no significant device or system failures despite a cumulative patient experience of 24.8 years outside of a hospital environment. Patient selection and management varied greatly between centres and this was reflected in disparate outcomes. Conclusions: Optimal selection and management of LVAS patients has still to be established. While the data available for this report lacked the detail necessary to demonstrate direct causal relationships between selection and management, it was clear from the inter-centre differences that these two factors have a major impact on outcomes. This early experience has directed attention towards improved management regimes. Given the results obtained from the best centres and the ability to discharge patients to lead near-normal lives in the community, the authors believe that the Novacor LVAS now offers a real therapeutic alternative for selected end-stage heart failure patients for whom a donor heart is unavailable or who are unsuitable for transplantation.",
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