Potential of left ventricular assist devices as outpatient therapy while awaiting transplantation

Left ventricular assist devices (LVADs) increasingly are being used as a bridge to transplantation. We studied changes in New York Heart Association class, mean arterial pressure, resting cardiac output, end-organ function, exercise oxygen consumption, and exercise cardiac output in 12 LVAD recipients. In addition, resting levels of neurohormonal factors were evaluated 4 to 16 weeks after implantation. Two of the 12 patients died of right heart failure and 1 of aspiration; all deaths occurred in the first 2 weeks after LVAD implantation. Of the other 9 patients, 8 improved to New York Heart Association class I and 1 to class II, all of whom were in class IV preoperatively. The 4 patients who underwent exercise testing achieved an exercise oxygen consumption of 15.0 ± 2.7 mL · kg^-1 · min^-1, which was paralleled by an increase in resting cardiac output from 3.07 ± 0.9 L · min^-1 preoperatively to 5.66 ± 1.1 L · min^-1 at 2 months, and mean arterial pressure from 60 ± 8 to 91 ± 10 mm Hg at 2 months, a benefit that was maintained for up to 10 months. End-organ function revealed comparable improvement at 2 months for both creatinine (1.68 ± 0.7 to 1.0 ± 0.19 mg · dL^-1) and total bilirubin (1.37 ± 1.17 to 0.54 ± 0.26 mg · dL^-1) levels. Levels of neurohormones were within normal limits. Adverse clinical events after the perioperative period were minimal, and no thromboembolic complications occurred. These data indicate that functional and physiologic recovery occurs during LVAD support, that adverse clinical and mechanical events occurring after the perioperative period are few and should not preclude hospital discharge in selected patients, and thus that LVADs can provide reliable, long-term support and should be evaluated for future use as outpatient therapy.