Langzeitanwendung der biventrikulären Kreislaufunterstützung typ Berlin Heart

As transplant waiting times have lengthened, the need for long-term mechanical support has grown. In patients presenting with severe cardiogenic shock evolving multiorgan failure, we use the Berlin Heart biventricular support system. We describe 33 patients who were on BVAD support for more than 150 days. There were 27 male (82%) and 6 female (18%) with a mean age of 45 ± 10.7 years (range 24-62 years). The indication for BVAD was dilated in 24 cases, restrictive in 3 cases, and ischemic cardiomyopathies in 6 cases. These patients were followed for infections, thromboembolic events, bleeding complications, and psychologic effect of BVAD placement. Our experience shows that 32 patients (97%) recovered completely from secondary organ dysfunction. This was required prior to heart transplantation. After 120 days, infections of the transcutaneous canula site were common. Coagulase negative staphylococcus was the most common cultured microbacteria. With appropriate antibiotic therapy, this did not preclude transplantation. The paracorporeally placed heparine-coated transparent polyurethane chambers are inspected daily for fibrin formation. If any formations are noted, the device is changed or cleaned. With an aggressive anticoagulation and antiaggregation protocol, the thromboembolic and bleeding events are minimized. Eleven patients (33%) died after a mean duration of 303 days (range 150-552 days) while waiting for transplant: two died from intracranial bleeding, seven from sepsis, one from a non-related cause (amyloidose) and one patient from a traumatic accident by sexual activity. Two patients (6%) are presently waiting for transplant with BVAD and twenty patients (60%) were transplanted after a mean time of 286 days (range 152-571 days). The results of heart transplant following long-term BVAD application were acceptable. Only three patients died. Twenty-one patients were discharged home with BVADs while awaiting transplant.