Initial Australian experience with the Thoratec ventricular assist device

The Thoratec ventricular assist device consists of a polyurethane prosthetic ventricle with a 65 mL pumping chamber, dedicated atrial or ventricular inflow cannulae, an arterial outflow conduit and a pneumatic drive console. Since July 1990, this device has been used in 9 patients with cardiogenic shock. Of these, 6 were implanted as a bridge to transplantation or retransplantation, 2 were implanted to allow recovery of the native heart following coronary artery surgery and acute myocardial infarction, and 1 for primary cardiac allograft dysfunction soon after transplantation. Left ventricular assist alone was used in 7 patients and biventricular assist in the remaining 2 patients. Flow rates of 3.5 to 5.0 L/min were achieved. Support was maintained for an average of 17 days (range 6 hours to 61 days), with a total support experience of 154 days. Of the 6 bridge-to-transplantation patients, 4 subsequently underwent cardiac transplantation or retransplantation, 3 of whom are alive and well at a follow-up of 5 to 14 months. The remaining 3 of the 9 patients supported developed major morbidity from thromboembolism, sepsis or lower-limb ischaemia while being successfully supported and had support withdrawn. The Thoratec ventricular assist device is capable of chronically supporting the circulation of the critically ill patient in a preterminal state despite maximal medical therapy.