Implantation figures

Of the total of 412 assist devices implanted in LMU Grosshadern Clinic between 1992 and December 2010 (see Fig. 1), extracorporeal membrane oxygenation using the Biomedicus centrifugal pump (ECMO, n=222) was used most often as short-term support for up to a week to relieve the heart and lungs because of problems in the operating theatre, e.g. when coming off the heart-lung machine.

The second most frequently used device was the Novacor electromechanically operated isolated left ventricular assist device, which has been employed in 53 patients. This was used as a long-term assist device for an average of 100 days until transplantation. This was usually as a medium-term bridge to transplantation until cardiac transplantation of NYHA class IV patients. In the long term, the Novacor will also be used as a permanent heart replacement as an alternative to cardiac transplantation (“destination therapy”, as in two Novacor patients in our hospital who were not candidates for a heart transplant because of their age over 70 years and their comorbidities).

The Jarvik 2000 should also ensure that permanent life-long support of the left heart is possible. It has been used 21 times in our clinic since January 2008, three times with an abdominal cable exit.

Our clinic has used the Berlin Heart (n = 76) and Medos system (n = 23) as pericorporeal long-term bridging systems for both ventricles. The advantage and special usefulness for our clinic of these systems, which operate by compressed air, was uni- or biventricular use and use with the most varied ventricle sizes in children and infants.

In the period from 1997 to 2003 other pumps, especially axial pumps such as the DeBakey heart developed by NASA or the Hemopump or Impella pump, which work according to the Archimedes screw principle, were tested, and also the Abiomed, which has atria in addition. However, these did not have any advantages. We have therefore concentrated in recent years on the ECMO as a short-term system, on the Novacor or Jarvik 2000 as a long-term left ventricular system and on the Berlin Heart Excor as a right or biventricular system, which is also used in children, especially on account of its good pump output of up to 10 L/min. The quality of life of assist device patients has improved considerably over the last 10 years but still lags far behind that of heart transplant patients.