Ventricular-Assist Devices Help Patients Wait for Cardiac Transplantation at Hom

Doctor's Guide

Patients who need ventricular assist devices (VAD) while waiting for a heart transplant can leave the hospital and go home without increasing their mortality risk.

Researchers in Germany and in the United States found that patients who were sent home wearing the devices may have done better than the patients who stayed in the hospital.

“These patients who go home with their VAD are able to regain a remarkable level of physical activity,” said Matthias Loebe, MD, PhD, assistant professor in the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, in Houston, Texas. “In addition, they also regain an acceptable quality of life.”

Dr. Loebe, speaking yesterday at the 38th annual meeting of the Society of Thoracic Surgeons (STS), reported on two sets of patients — a group in the Germany Heart Institute, in Berlin, and a smaller group in Houston.

Patients who wanted to wait for their transplants at home — on average for more than a year — were trained in how to prevent infections and had available hospital technical and medical support on a 24-hour, seven-day-a-week basis. In Germany, 38 patients were able to go home with the devices, and their outcomes were compared with 71 patients who remained in the hospital.

Overall, Dr. Loebe reported that the mortality rate among those who went home was about 18 percent, with six of the 38 patients dying. In the hospital setting, the mortality rate was 42 percent, with 30 of 71 patients dying.

Of the 38 at-home patients, 30 (79 percent) required readmission to the hospital, mainly for non-cardiac reasons (36 of 66 readmissions). Dr. Loebe said that these patients required hospitalisation about once every five months.

The results in Houston were similar, although there were fewer patients. Thirteen patients were able to go home and 14 stayed in the hospital. The mortality was 54 percent among the in-hospital patients and 21 percent among those who were at home.

One of the at-home Houston patients required readmission due to treatment of a scorpion bite, something, Dr. Loebe joked, “would not have been anticipated among the German patients.” He said that some patients were able to get out of their homes and even go on motorbike trips once out of the hospital.

“Our experience shows that the use of mechanical circulatory support in out-patients can be performed without increased mortality and with an acceptable rate of readmissions.” However, Dr. Loebe said that the prerequisite for the program is extensive training of the patient, a home caregiver, and dedicated hospital and auxiliary staffs.