The wearable Novacor LVAS at Henri Mondor Hospital

Summary

From March 1993 to February 1996, 8 patients have been selected, from a group of 40 patients in cardiogenic shock, referred for urgent cardiac transplantation. Immediate hemodynamical improvement allowed a rapid favorable evolution of organ dysfunction, a weaning off any IV inotropic support. The late evolution was as follows: one patient still on device after 164 days living at home. One patient died at 201 days as a result of the psychological sequellae of an embolic episode. Six patients have been transplanted, with a successful outcome in 5.

The experience allows comments on the problems related to right ventricular function, hemorrhagic and thrombo embolic complication and infection.

In the early 1970s, P. Portner introduced the concept of an implantable left ventricular assist device, connected between the left ventricular apex and the aorta, electrically powered, allowing prolonged survival. The system was designed to offer an alternative to cardiac transplantation. Since that period, continuous technological developments have permitted to evolve from an extracorporeal console based system towards the fully implantable system: in 1993, the wearable configuration was used clinically for the first time at Henri Mondor’s hospital and rapidly adopted by many groups throughout Europe. This initial experience allows to evaluate the real problems raised by the survival of patients, suffering a major cardiac dysfunction, and about to die. These problems are of a clinical and technological nature. They also include ethical issues and economical considerations.

Analysis of the first eight cases of our group is the substance of the present report.