Univentricular support in a bridge-to-transplant experience

Abstract

From July 1987 to September 1989, investigators at the Presbyterian University Hospital of the University of Pittsburgh evaluated, in lieu of the pneumatic total artificial heart [1], the usefulness of a left ventricular assist device as a univentricular mechanical bridge to cardiac transplantation in 14 candidates mortally ill with biventricular congestive heart failure. We acknowledged that a potentially simpler univentricular system might provide a developmental advantage over a total artificial heart en route to an idealized totally implantable system capable of long-term and quality therapy for end-stage heart disease. In part, this decision was based on our earlier experiences of an unacceptable rate of mediastinitis with the total artificial heart [2]. We chosen the Novacor left ventricular assist system (LVAS) in its currently available temporary configuration with transcutaneous power cord because its early application as a bridge to transplant appeared promising and because its more advanced totally implantable system has already been successfully tested in animals [3]. This report describes the results of univentricular support and focuses on its effect on right heart function and hemodynamics.