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The Novacor left ventricular assist system (LVAS) has been used as a bridge to cardiac transplantation in 22 patients at Stanford University since September 1984. All patients were in hospital receiving inotropic support for severe biventricular failure. Nine were supported by an intra-aortic balloon pump, 17 had pulmonary oedema, seven had life-threatening ventricular arrhythmias, 10 had liver dysfunction with coagulopathy, and seven had renal dysfunction. Prior to implantation the mean cardiac index was 1.6 L/min/m2, which rose to 3.3 L/min/m2 following device insertion. Two patients died during implantation, and four died from multiorgan failure after device implantation. The majority of patients who had been supported for more than 1 week were ambulatory while awaiting transplantation. One patient received the recently developed system with a wearable battery/controller. Sixteen patients (73%) underwent successful cardiac transplantation after a mean of 21 days support. One patient died of sepsis, and another died of malignancy following transplantation. Fourteen patients (88%) were alive 1 month to 9 years after transplantation. Worldwide, as of November 1993, 176 patients have had the Novacor LVAS implanted (including 17 with the wearable system). Twelve were still being supported, 101(60%) had received a transplant, and 92 (91%) of these were discharged from hospital. There were 82 (89%) survivors at a mean of 30 months post-transplantation. No episodes of device failure have occurred. The post-transplant survival in this group of patients bridged to transplantation was similar to those having routine transplantation. The wearable system has provided greater patient freedom. Future development will be towards a totally implantable LVAS.
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