Clinical benefits of partial circulatory support in New York Heart Association Class IIIB and Early Class IV patients

BP Meyns, A Simon, S Klotz, T Wittwer, C Schlensak, F Rega and D Burkhoff
Eur J Cardiothorac.Surg. 2010;39:693-698

Objective: Full mechanical support with a left-ventricular assist device (LVAD) is generally limited to end-stage heart-failure patients. We have been studying the safety and efficacy of the partial support Synergy((R)) Pocket Micro-pump as bridge-to-transplant in a less-sick group of patients as a prelude to a study of its use for destination therapy. Methods: The CircuLite((R)) Synergy device is implanted via a small right-sided thoracotomy with an inflow cannula in the left atrium and an outflow graft connected to the right subclavian artery without the use of extracorporeal circulation. The micro-pump is the size of an AA battery, sits in the ‘pacemaker’ pocket subcutaneously in the right clavicular groove and pumps up to 3.0lmin(-1) from the left atrium to the right subclavian artery. Results: The device has been implanted in 27 patients awaiting cardiac transplant (22 males), age 54.8+/-10.0 years with ejection fraction (EF) 21+/-6%, mean arterial pressure 73.5+/-8.8mmHg, pulmonary capillary wedge pressure (PCWP) 27.5+/-7.8mmHg and cardiac index (CI) 2.0+/-0.4lmin(-1)m(-2). Duration of support has ranged from 6 to 281 days. Right-heart catheterization showed significant hemodynamic improvement in the short- and intermediate term after implant, with increases in CI from 2.0+/-0.4 to 2.8+/-0.6lmin(-1)m(-2) (p

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