European Heart Journal Advance Access originally published online on March 30, 2005
European Heart Journal 2005 26(10):1031-1038; doi:10.1093/eurheartj/ehi163
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Advanced heart failure: feasibility study of long-term continuous axial flow pump support
1Center for Cardiovascular Disease, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106 Freiburg, Germany
2John Radcliffe Hospital, Oxford, UK
3Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
4Royal Brompton and Harefield Hospital Trust and Imperial College, London, UK
Received 9 August 2004; revised 4 January 2005; accepted 6 January 2005; online publish-ahead-of-print 30 March 2005.
* Corresponding author. Tel: +49 761 270 6138; fax: +49 761 270 2550. E-mail address: siegenth{at}ch11.ukl.uni-freiburg.de
See page 953 for the editorial comment on this article (doi:10.1093/eurheartj/ehi233)
Aims A lack of donor hearts has stimulated interest in using blood pumps to treat severe heart failure. We tested the hypothesis that a new continuous flow circulatory assist device could be employed safely to relieve symptoms of heart failure and evaluated the potential to prolong life.
Methods and results An intracardiac axial flow pump was implanted in 17 heart failure patients [idiopathic dilated (12), ischaemic (4), or amyloid cardiomyopathy (1)]. All were deemed ineligible for transplantation. Implantation of the device was by left thoracotomy (15) or median sternotomy (2). Power delivery was by a skull-mounted titanium pedestal. All patients survived surgery. None needed right ventricular support. There were three hospital deaths, two early from subdural haematoma and aortic thrombosis, one late after switching to transplantation. A total of 14 patients left hospital with a cumulative support-time of 15.9 years (median: 293 days, interquartile range: 286 days, 1–44 months). Actuarial 1-, 2-, and 3-year survivals were 56, 47, and 24%, respectively. There was no pump failure. Quality of life scores improved. Two superficial pedestal infections were successfully treated. Four patients had cerebral thrombo-embolism: two early events attributed to inadequate anticoagulation and two late with near-complete resolution. An improved anticoagulant regime addressed this problem. Late death occurred in five patients from battery disconnection, subdural haematoma, bowel ischaemia, respiratory failure, and after cardiac transplantation.
Conclusion Continuous flow blood pumps provided symptomatic relief of severe heart failure with high quality of life. Event-free survival reached 4 years. Analysis of adverse events led to improved management strategies. There is potential for widespread use of blood pumps in the community. A controlled trial is required.
Key Words: Heart failure • Circulatory support • Lifetime use • Destination therapy • Jarvik 2000 • Complications
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