Bridge-to-decision therapy with a continuous-flow external ventricular assist device in refractory XXXX of various causes.

@entity1 @entity548 @entity1457 @entity715 @entity67 @entity1455
BACKGROUND: Mortality for refractory @entity1455 remains high. In this @entity1 cohort, there have been mixed results in mechanical circulatory support device use as a bridge-to-decision therapy. We evaluated a continuous-flow external ventricular assist device (VAD), CentriMag VAD (Thoratec Corp., Pleasanton, CA), in @entity1 with various causes of refractory @entity1455 . METHODS AND RESULTS: This is a retrospective review of adult @entity1 who underwent surgical CentriMag VAD insertion as bridge-to-decision therapy. From January 2007 through June 2012, 143 @entity1 received CentriMag VAD. The cause of refractory @entity1455 was failure of medical management in 71 @entity1 , @entity1457 in 37, graft failure post-heart transplantation in 22, and @entity67 post-implantable left VAD in 13. Mean age was 52  16 years, and 71% were in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 1. Among 158 device runs, device configuration was BiVAD in 67%, isolated right VAD in 26%, and isolated left VAD in 8%. Median duration of support was 14 days (interquartile range, 8-26). Survival was 69% at 30 days and 49% at 1 year. The next destination after the CentriMag VAD was myocardial recovery in 30%, device exchange to an implantable VAD in 15%, and heart transplantation in 18%. The failure of medical management and the graft failure post-heart transplantation groups had higher 30-day survival compared with the @entity1457 group. Major @entity548 events occurred in 33% and cerebrovascular accidents in 14%. There was no CentriMag pump failure or @entity715 . CONCLUSIONS: Bridge-to-decision therapy with CentriMag VAD is feasible in a variety of refractory @entity1455 settings. @entity1 with @entity1457 have inferior survival.
