The Novacor Left Ventricular Assist System: Lessons Learned

The purpose of this investigation is to identify the factors influencing the outcome of the Novacor left ventricular assist system (LV AS) as a bridge to transplant. Novacor LV ASs were placed for transplant candidates refractory to medical therapy. All LV ASs were performed on cardiopulmonary bypass without aortic cross clamping. Postoperative care was instituted per protocol. From October 9, 1993, to October 29, 1996, 17 Novacor LV ASs were placed as a bridge to transplantation. There were I 5 male and 2 female patients. The mean age was 52 years (16-66 years). The mean time interval from listing for orthotopic heart transplantation (OHT) to LV AS insertion was 55 days (1-307 days). The mean cardiopulmonary bypass time was 108 minutes (53-300 minutes). Ten (59%) patients were subsequently transplanted. Prior to transplant, seven (41%) patients expired of neurologic sequellae, right ventricular failure, or sepsis syndrome. The mean duration of LVAS support to transplantation was 31 days (1-76 days). The average blood loss for the first 24 hours was 4096 ml (500-16,105 ml). Eight patients remain alive at a mean follow-up of 13 months (1-22 months). Two patients expired of heart failure following transplantation. Preoperative cardiogenic shock and infection result in poor outcome following LV AS insertion. Severe right ventricular (RV) dysfunction requires prompt RV AD placement. Correction of preoperative coagulopathy and meticulous hemostasis are critical.