ONE YEAR EXPERIENCE OF THORATEC
VENTRICULAR ASSIST DEVICE PROGRAMME BRIDGING TO TRANSPLANT AT ROYAL PERTH
HOSPITAL J.G.
O'Driscoll, R. Larbalestier, H.M.Hayes*, C.A.Wood, M. Lovett Cardiac
Transplant Unit, Royal Perth Hospital, Perth, Western
Australia. Background: Despite the success of orthotopic
heart transplantation, donor shortage, geographical isolation of W.A. and
increased waiting times remain significant problems. Mechanical circulatory
support used as a bridge to cardiac transplantation is now a firmly established
treatment modality. The Thoratec TLC II
VAD can be applied for univentricular or biventricular support. This
paper outlines the clinical outcomes, in terms of the complications associated
with long term VAD support, morbidity/mortality, sepsis and embolus, and the
cost benefit related to the establishment of a community based VAD programme. Method: Prior to the insertion of a Thoratec LVAD
all patients were managed utilizing inotropic and IABP therapy. Mean age was 34
years (21-50yrs), 4 male and 1 female. Aetiologies included; ischaemic, dilated
and post partum cardiomyopathy. A Patients discharged with the Thoratec VAD
completed competency based training and provided 24 hour support from a
nominated carer. Results:
The total number of days on LVAD support was 479 days (0 +/- 290). 2
patients were successfully bridged to cardiac transplantation, 1 after 290 days
support and 1 after 11 days support. A third patient remains supported at home
awaiting transplantation. 2 patients died within 24 hours of VAD insertion, due
to pulmonary embolus and cardiac failure of unknown aetiology. Post VAD
inpatient complications have included temporal lobe infarct and sepsis. 2
patients have been managed in the community accounting for 26% (125/479) of the
total days on VAD support, representing a significant cost saving . Average bed
day cost $690 (Metropolitian Health Service Board Annual Report 1997/1998). To
date there have been no major complications associated with managing these
patients in the community. Conclusion: Thoratec VAD support in the
community is an acceptable method of bridging patients to cardiac
transplantation offering an improved quality of life for the patient, full
mobilization and a significant cost saving related to decreased inpatient
admissions.
