[Mechanical circulatory support: 15 years of experience in the Heart Center North Rhine-Westphalia]. / Mechanische Kreislaufunterstützung--15 Jahre Erfahrung im Herzzentrum Nordrhein-Westfalen.

ABSTRACT

OBJECTIVES: Against the background of an increasing number of patients suffering from severe congestive heart failure, mechanical circulatory support becomes more and more important. The indications for this therapeutic option ranges from bridging to cardiac transplantation, the application of the most recent systems as an alternative to transplantation, as well as in cardiogenic shock following open-heart surgery, acute myocardial infarction of fulminant myocarditis. PATIENTS AND METHODS: Between September 1987 and November 2002, 670 implantations of 11 different mechanical circulatory support systems were performed in 607 patients (125 women, 482 men, age 1 month - 82 years). 255 patients received the device as a bridge to recovery (BTR) of their native organ, 276 patients as a bridge to cardiac transplantation (BTT), 49 patients as an emergency measure in life-threatening cardiogenic shock (bridge-to-bridge, BTB), and 27 patients as an alternative to transplantation (ATT). RESULTS: 38% of the BTR group, 56% of the BTT group, 34% of the BTB group and 27% of the ATT group underwent successful cardiac transplantation or could be discharged from hospital. Infections and thromboembolic events were the most frequent complications but decreased with increasing experience and sophistication of devices. Some systems offer the possibility of discharging patients home while on the device. In our cohort, 90 patients left the hospital on support for a mean duration of 204 days. Readmission rate after 200 days was 50% and was system-related in less than 6%. CONCLUSIONS: In spite of a still considerable morbidity associated with the employment of mechanical circulatory support, the results are encouraging and justify the high economic burden.