82: Evolving use of left ventricular (LVAD) vs biventricular (BiVAD) assist devices

Purpose: Ventricular Assist Devices (VAD) are effective in severe end-stage cardiac failure but results remain poor in moribund patients. Cheaper and less invasive short-term devices have been used in this setting. We report our experience with Levitronix short-term VAD as a potential bridge prior to deciding if a more expensive device or transplant should be used. Methods and Materials: Since June 2003, 18 critically ill patients [15 M; age 34.3 14.1 (range 12-62) years] were supported with a Levitronix. Six had an intra-aortic balloon pump pre-operatively (IABP), 7 had multi-organ failure (MOF). In 8 cases Levitronix were salvage procedures (SP). Results: Operative (30-day) mortality was 27.8% (5 pts). The follow-up was 7.3 9.9 (range 0-30) months. There were 4 late deaths (22.2%) while assisted on Levitronix. Nine patients (50%) were successfully bridged (2 IABP, 4 MOF, 4 SP): 3 patients to recovery, 1 to a long-term device as bridge to transplantation, 3 were transplanted and 2 patients are on the waiting list for transplantation. They are presently alive and well. Overall survival at 6 months and one year was 38.9% (7 patients) and 27.8% (5 patients) respectively. Support time was 32.8 33.3 (range 3-118) days. There were no device failures. Five patients (27.8%) were re-operated for bleeding. Conclusions: Our data suggest that Levitronix is effective in rescuing critically ill patients providing a cheaper opportunity to support and optimize conditions prior to deciding if a more expensive device or transplant should be used. In this way better candidate selection for further procedures can occur.