Recovery of major organ function in patients awaiting heart transplantation with Thoratec ventricular assist devices. Thoratec Ventricular Assist Device Principal Investigators.

The time course of recovery of hepatic and renal function was determined in 193 patients receiving Thoratec ventricular assist devices while awaiting transplantation at 41 hospitals in eight countries. The duration of circulatory support averaged 26 days (maximum 248 days) and the average ventricular assist device blood flow index was 2.7 +/- 0.5 L/min/m2 compared with a preoperative cardiac index of 1.4 +/- 0.7 L/min/m2. Renal and hepatic function improved in most patients in 1 to 3 weeks of support. When comparing patients with the longest durations on the ventricular assist device (60 to 248 days) to patients with the shortest durations (< 7 days), laboratory values were significantly improved: creatinine (-29%, from 1.7 +/- 1.2 to 1.2 +/- 0.5 mg/dl), blood urea nitrogen (-32%, from 37 +/- 27 to 25 +/- 14 mg/dl), serum glutamic-oxaloacetic transaminase (-81%, from 397 +/- 702 to 76 +/- 45 IU) and total bilirubin (-79%, from 7.0 +/- 8.6 to 1.5 +/- 0.7 mg/dl). However, the posttransplantation survival through hospital discharge was not significantly different: 88% (14 of 16) for patients supported for at least 60 days and 86% (43 of 50) for patients who underwent transplantation after only 1 week of support. Therefore renal and hepatic function improve during ventricular assist device support, but the survival rate after transplantation is not related to duration and is comparable to that of conventional heart transplantation for short or long periods of ventricular assist support. Although it is clearly important not to proceed to transplantation in patients with irreversible organ failure who have ventricular assist devices, these data suggest that as long as the patient is on the path to recovery, the outcome is basically the same as for patients who have full recovery of renal and hepatic function.