Overcoming Disparities In U.S. Health Care

Abstract available at publisher's website.http://dx.doi.org/10.1377/hlthaff.24.2.44

Long-Term Clinical Use of the Novacor Left Ventricular Assist Device as a Bridge to Transplantation

The Novacor left ventricular assist device (NLVAD) is an implantable, electrically powered, pulsatile circulatory assist device undergoing clinical investigation. This report reviews the 33-day bridge-to-transplant course of a patient presenting in cardiogenic shock after acute myocardial infarction who could not be weaned from cardiopulmonary bypass following emergency coronary artery revascularization. Cardiac output was satisfactory during the entire 33-day period: 4.2 ± 0.8 1/min (± SD) during the first week and 6.3 ± 0.9 thereafter. Haptoglobin remained low (30 ± 4 mg%), suggesting mild hemolysis, but plasma hemoglobin remained normal throughout and the patient required only 600 ml of blood after the first two postoperative days. Renal impairment (peak creatinine = 2.9 mg/dl on day three) was attributed to preoperative hypotension and resolved by day seven. The clinical course included pneumonia and hypoxic encephalopathy, both of which resolved. There were no thromboembolic complications or device-related infections. The patient underwent orthotopic cardiac transplantation on day 33. This case demonstrates the long term clinical efficacy and safety of the NLVAD in the setting of cardiogenic shock after massive myocardial infarction as a bridge-to-transplant support system