The thoratec ventricular assist device: a paracorporeal pump for treating acute and chronic heart failure.

The Thoratec Ventricular Assist Device (VAD) System (Thoratec Laboratories, Pleasanton, CA) is a paracorporeal pump that can provide univentricular or biventricular assistance for patients with heart failure. The system consists of a prosthetic ventricle that has a blood-pumping chamber of Thoralon (Thoratec Laboratories) polyurethane, cannulas for univentricular or biventricular support, and either a hospital-based pneumatic drive console or a portable battery-powered drive unit. For biventricular assistance, 2 pumps are used. The Thoratec voluntary registry indicates that, as of May 2000, this system had been implanted in 1,376 patients, mainly for bridging to transplantation (828 patients) or postcardiotomy support (195 patients); the remaining 353 patients received a hybrid configuration of the device or had incomplete information, so they are not included in this analysis. In the 828 bridge-to-transplant patients, the Thoratec system provided biventricular assistance in 472 cases, left ventricular assistance in 326 cases, and right ventricular assistance in 30 cases for up to 515 days. During the support period, the cardiac index increased significantly from 1.4 +/- 0.8 L/min/m2 to 3.0 +/- 0.5 L/min/m2 (with biventricular assistance and left ventricular cannulation). Sixty percent of the 828 patients underwent transplantation, and the posttransplant survival rate was 86%. In the 195 patients who needed postcardiotomy support, VADs were used for up to 80 days for cardiac recovery. Thirty-eight percent of the patients were weaned from the VAD, and 59% of the weaned group were discharged from the hospital. In addition, 49 postcardiotomy patients were considered for transplantation; of these, 32 received a transplant and 23 were discharged. Patient mobility is being improved by the use of a portable driver. The Thoratec VAD is suitable for a wide range of applications, and efforts are underway to facilitate patient mobility and allow hospital discharge. An intracorporeal version of the VAD, which is currently under development, will help achieve these goals.