The Thoratec Implantable Ventricular Assist Device (IVAD): Initial Clinical Experience
Background. The Thoratec Implantable Ventricular Assist Device (IVAD) is the only FDA-approved intracorporeal biventricular cardiac assist device. It is a titanium-coated version of its predecessor, the Paracorporeal Ventricular Assist Device (PVAD). The blood pump is compatible with the portable TLC-II driver, making home discharge feasible.
Methods. Nine consecutive patients were implanted with the IVAD from June 2005 through March 2006. The indications for support were acute heart failure in 6 cases and chronic heart failure in 3 cases. All patients were managed with maximal medical therapies including intravenous inotropic drugs prior to implant.
Results. All patients survived the surgical implant. Six patients were considered successful: 3 patients discharged to home and subsequently received transplantation, 2 are awaiting transplantation (1 at home and 1 in-house), and 1 patient was successfully explanted. Three patients expired postoperatively because of multiple organ system failure (2 patients) and pulmonary hemorrhage (1 patient). There were no device malfunctions. There was 1 localized driveline site infection and 1 thromboembolic event with partial visual loss.
Conclusions. The IVAD is a unique device capable of providing uni- or bi-ventricular support for either acute or chronic heart failure conditions. Its versatility permits bridge to transplant or recovery options. Home discharge is feasible.
Farrar DJ, Reichenbach SH, Rossi SA, Weidman JR. 2000. Development of an intracorporeal Thoratec ventricular assist device for univentricular or biventricular support. ASAIO J 46:351-3.nReichenbach SH, Farrar DJ, Hill JD. 2001. A versatile intracorporeal ventricular assist device based on the thoratec VAD system. Ann Thorac Surg 71(Suppl 3):S171-5; discussion S183-4.nSamuels L. Biventricular mechanical replacement. 2004. Surg Clin North Am 84:309-21.n
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