Use of ventricular assist device (VAD) in patient with end-stage valvular heart disease

Summary

For the last 2 years, we have used ventricular assist devices (VADs) in 5 patients with severe valvular heart disease who could not be weaned from cardiopulmonary bypass. For left ventricular assist devices (LVADs), the pump types used were 3 diaphragm-type, 1 pusher-plate type, and 1 centrifugal. For the right ventricular assist device (RVAD), 1 diaphragm-type pump was used. The age of the 5 patients ranged from 22 to 59 years (mean 43). Four patients with combined aortic and mitral valvular disease underwent aortic and mitral valve replacements. One patient with annuloaortic ectosia (AAE) underwent the Cabrol procedure. Cardiopulmonary bypass time ranged from 290 to 586 min (mean 301) and aortic clamp time ranged from 208 to 442 min (mean 281). LVADs supported 4 patients for 4.5–8.5 days, and one had a biventricular assist device (BVAD) for 9.5 days. All patients were weaned from VADs and 2 patients were discharged from the hospital in NYHA functional class II. Three patients died of multiorgan failure, on the 18th, 60th, and 59th day. In 2 patients who died, the maximum values of free hemoglobin, lactate, and neutrophil elastase were 34 mg/dl, 46.6 mg/dl, and 1340 µg/l, respectively. The lowest value of antithrombin III was 34.5%. In 2 survivors, these values were 5.6, 22.8, 418, and 57.5% respectively. These data suggest that VADs are capable of supporting these high risk patients who are in postcardiotomy shock.