Patient selection for the ventricular assist device

Introduction

In addition to their use as a bridge-to-transplant, a bridge-to-recovery and as destination therapy, ventricular assist devices (VADs) are increasingly being used on patients 'in extremis' as a salvage procedure, as a bridge to a long-term device. We performed a retrospective analysis of the clinical criteria for VAD insertion in patients who have received devices.

Methods

Data were collected for all patients receiving a VAD in the last year, excluding those patients with a previous transplant or VAD. On each patient the following data were collected: age and degree of urgency of referral, diagnosis and duration of illness, pre-operative systems review within 24 hours of device insertion, device inserted, and outcome.

Results

Fifteen patients were included. Three groups of five patients emerged based on the referral pattern and duration of illness. Group 1, emergency (less than 2 weeks illness) – ischaemic and postpartum cardiomyopathy, acute myocardial infarction, myocarditis. Group 2, acute (less than 4 weeks illness) – postpartum and dilated cardiomyopathy. Group 3, elective (assessed for transplantation) – dilated and ischaemic cardiomyopathy. See Table 1.

Table 1

Conclusion

Once patients require inotropic support, early referral is preferred. Recent onset renal and liver dysfunction due to poor ventricular function will be improved with a VAD. The onset of a metabolic acidosis is a predictor of poor outcome but a salvage procedure is possible in most patients with acute ventricular dysfunction.