Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist Device
Francis D. Pagani, MD, PhD*,*,
Leslie W. Miller, MD ,
Stuart D. Russell, MD ,
Keith D. Aaronson, MD*,
Ranjit John, MD ,
Andrew J. Boyle, MD,
John V. Conte, MD,
Roberta C. Bogaev, MD||,
Thomas E. MacGillivray, MD¶,
Yoshifumi Naka, MD#,
Donna Mancini, MD#,
H. Todd Massey, MD**,
Leway Chen, MD**,
Charles T. Klodell, MD,
Juan M. Aranda, MD,
Nader Moazami, MD,
Gregory A. Ewald, MD,
David J. Farrar, PhD,
O. Howard Frazier, MD|| for the HeartMate II Investigators
* University of Michigan, Ann Arbor, Michigan
Washington Hospital Center, Washington, DC
Johns Hopkins Hospital, Baltimore, Maryland
University of Minnesota, Minneapolis, Minnesota
|| Texas Heart Institute, Houston, Texas
¶ Massachusetts General Hospital, Boston, Massachusetts
# Columbia University, New York, New York
** University of Rochester, Rochester, New York
University of Florida, Gainesville, Florida
Barnes-Jewish Hospital, St. Louis, Missouri
Thoratec Corporation, Pleasanton, California
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Figure 1 Components of the Continuous-Flow LVAD
(A) The inflow cannula is inserted into the apex of the left ventricle, and the outflow cannula is anastomosed to the ascending aorta. Blood exits through the left ventricular apex and into the left ventricular assist device (LVAD), which pumps throughout cardiac diastole and systole into the ascending aorta. (B) The LVAD pump is placed within the abdominal wall or peritoneal cavity. A percutaneous lead carries the electrical cable to an electronic controller and battery packs, which are worn on a belt and shoulder holster, respectively.
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Figure 2 Outcomes for 281 Patients After Implantation of the Continuous-Flow Left Ventricular Assist Device
Competing outcomes analysis of patients undergoing implantation of the continuous-flow left ventricular assist device for the first 18 months after device implantation.
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Figure 3 Kaplan-Meier Survival Analysis
Survival analysis for patients who continued to receive support with the continuous-flow left ventricular assist device censored at the time of heart transplantation and device explantation for cardiac recovery.
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Figure 4 Kaplan-Meier Analysis of the Freedom From Major Device Malfunction
Analysis of freedom from major device malfunction was defined as the freedom from death as the result of major device malfunction or need for device replacement for all causes including device malfunction, thrombosis, or infection.
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