Abstract
Background. Due to the shortage of donor hearts, mechanical circulatory support is increasingly being used as a bridge to transplantation. In order to allow for more widespread use of ventricular assist devices it is mandatory that patients are not continuously hospitalised. We present the results of our experience with patients with end-stage heart failure, discharged from hospital after implantation of a ventricular assist device and followed in an outpatient setting.
Methods. After an intensive training and education programme, focusing on the management of the percutaneous driveline and instructions on how to handle in case of an alarm or malfunction of the device, patients were discharged. They were followed in the outpatient department. All regular and unplanned visits were registered, including readmissions.
Results. Twenty-seven patients treated with a ventricular assist device were discharged from hospital. There were 37 extra visits, of these, 27 were device related resulting in 21 readmissions (0.78/patient). We treated eight infectious episodes in four patients, all device related. Furthermore seven thromboembolic episodes occurred in four patients. One patient died because of multiorgan failure seven weeks after he was readmitted with an urosepsis. In our experience of 11.4 patient years at home while on the device, only 5% of the time was spent in hospital for complications. In comparison with patients on an assist device who stayed in hospital until transplantation, there were no more complications. Conclusion. This study demonstrates that patients with end-stage heart failure, treated with a ventricular assist device, can be safely discharged from hospital, with an acceptable rate of readmissions. It results in a fair quality of life, with a high degree of independence of the patient. (Neth Heart J 2007; 15:45-50.)
Similar content being viewed by others
References
Brophy JM, Joseph L, Rouleau JL. B-blockers in congestive heart failure. A Bayesian meta-analysis. Ann Int Med 2001;134:550-60.
Packer M, Coats AJ, Fowler MB, Katus HA, Krum H, Mohacsi P, et al., for the Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001;344:1651-8.
Chatterjee K. Refractory heart failure- drugs and devices. Eur Heart J 2001;22:2227-30.
Lahpor JR, de Jonge N, van Swieten HA, Wesenhagen H, Klöpping C, Geertman JH, et al. Left ventricular assist device as bridge to transplantation in patients with end-stage heart failure. Neth Heart J 2002;10:267-71.
de Jonge N, Kirkels H, Lahpor JR, Klopping C, Hulzebos EJ, de la Riviere AB, et al. Exercise performance in patients with endstage heart failure after implantation of a left ventricular assist device and after heart transplantation: an outlook for permanent assisting? J Am Coll Cardiol 200137:1794-9.
Kemperman H, van den Berg M, Kirkels H, de Jonge N. B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP in patients with end-stage Heart failure supported by a left ventricular assist device. Clin Chem 2004;50;1670-2.
Drews TN, Loebe M, Jurmann MJ, Weng Y, Wendelmuth C, Hetzer R. Outpatients on mechanical circulatory support. Ann Thor Surg 2003;75:780-5.
El-Banayosy A, Fey O, Sarnowski P, Arusoglu L, Boethiq D, Milting H, et al. Midterm follow-up of patients discharged from hospital under left ventricular assistance. J Heart Lung Transplant 2001; 20:53-8.
McCarthy PM, Smedira NO, Vargo RL, Goormastic M, Hobbs RE, Starling RC, et al. One hundred patients with the HeartMate left ventricular assist device: evolving concepts and technology. J Thorac Cardiovasc Surg 1998;115:904-12.
Rose EA, Levin HR, Oz MC, et al. Artificial circulatory support with textured interior surfaces. A counterintuitive approach to minimizing thromboembolism. Circulation 1994;90;[suppl II]:II-87-91.
Sinha P, Chen JM, Flannery M, Scully BE, Oz MC, Edwards MN. Infections during left ventricular assist device support do not affect posttransplant outcomes. Circulation 2000;102;[suppl III] III- 194-9.
Holman WL, Murrah CP, Ferguson ER, Bourge RC, McGriffin DC, Kirklin JK. Infections during extended circulatory support: University of Alabama at Birmingham experience 1989-1994. Ann Thorac Surg 1996;61:366-71.
Prendergast TW, Todd BA, Beyer AJ 3rd, Furukawa S, Eisen HJ, Addonizio VP, et al. Management of left ventricular assist device infection with Heart transplantation. Ann Thorac Surg 1997;64: 142-7.
El-Banayosy A, Arusoglu L, Kizner L, Tenderich G, Minami K, Inoue K, et al. Novacor left ventricular assist system versus Heart- Mate vented electric left ventricular assist system as a long-term mechanical circulatory support device in bridging patients: a prospective study. J Thorac Cardiovasc Surg 2000;119:581-7.
Grady KL, Meyer PM, Dressler D, White-Williams C, Kaan A, Mattea A, et al. Change in quality of life from before to after discharge post left ventricular assist device implantation. J Heart Lung Transplant 2003;22:322-33.
Dew MA, Kormos RL, Winowich S, Harris RC, Stanford EA, Carozza L, Griffith BP. Quality of life outcomes in left ventricular assist system inpatients and outpatients. ASAIO J 1999;45:218-25.
Author information
Authors and Affiliations
Corresponding author
Additional information
Heart Lung Centre Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
Correspondence to: A Oosterom, Heart Lung Centre Utrecht, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
Rights and permissions
About this article
Cite this article
Oosterom, A., de Jonge, N., Kirkels, J.H. et al. End-stage heart failure and mechanical circulatory support: feasibility of discharge from hospital. NHJL 15, 45–50 (2007). https://doi.org/10.1007/BF03085953
Issue Date:
DOI: https://doi.org/10.1007/BF03085953