The application of rotary blood pumps in patients with end-stage heart failure reveals a significantly reduced infectious complication rate as compared to the rate observed with pulsatile devices. The remaining adverse event rate relates mainly to thromboembolic complication with neurological consequences. We investigated the dependence of the neurological adverse event rate on the length of the inflow cannula.

As the duration of mechanical circulatory support now often exceeds one year in bridge to transplant procedures, the outcome of patients receiving extended circulatory support was analyzed.

Improvement of cardiac function by mechanically (assist device) unloading the left ventricle is frequently observed. The composition of different collagen fractions in the extracellular matrix may be a predictor for improvement.

Objectives: Since the early application of assist devices it has been a goal to have a totally wear-resistant system. INCOR, an axial flow pump for left heart support, has a virtually unlimited life due to magnetic suspension of the rotating impeller. An control algorithm avoids sucking in of the ventricle.

Purpose: We present the first results of our coagulation management in patients with the new axial flow pump Berlin Heart Incor. Methods: Between June and December 2002 the new axial flow pump was implanted in six patients. The diagnosis in three patients was dilatative cardiomyopathy (CMP) and in three ischemic CMP. The group was treated with a new anticoagulation concept consisting of anti-aggregation, anti-adhesion and anti-coagulation drugs and of rheologica. The mean support time was 110 days. Results: After the first two postoperative days the mean platelet count was 155.000/μl and results in platelet aggregation tests were normal, so that early anti-aggregation therapy with aspirin was necessary. Nevertheless one patient suffered a transient ischemic attack (TIA) on the eighth postoperative day. In total, four TIAs occurred in three patients (50%). In all these cases platelet anti-aggregation therapy was insufficient. No patient presented apoplexia and no patient died. None of the patients had to be reopened and none had gastrointestinal bleeding. In two patients transient epistaxis was seen. Four patients have left hospital; two are in the early postoperative stage. In one patient myocardial recovery occurred and the pump could be explanted. With the new axial flow pump Berlin Heart Incor early postoperative platelet recovery was seen, requiring early anti-aggregation therapy. Our coagulation protocol minimized the incidence of bleeding and embolic complications. It ensures the survival of the patients on MCS, is easy to perform, is not expensive and enables patients to be discharged home.

Introduction: To examine the effect of ventricular assist devices (VAD) on collagen content of the myocardium (MY) we analyzed tissue samples at implantation (TSIM) and at explantation (TSEX) of the VAD from the same heart (N=8). We compared these results with the collagen data from the MY of patients at implantation who were later weaned from the VAD (no transplantation) due to cardiac improvement (N=10; TSWE) and with tissue samples from unused donor hearts (N=13, TSUN).

Background: Routine annual coronary angiographies for transplant coronary artery disease [TxCAD] surveillance are risky, especially for renal failure due to chronic renal impairment induced by cyclosporine. After promising results for early TxCAD diagnosis obtained separately with pulsed-wave tissue Doppler imaging [PW-TDI] and electron beam computed tomography [EBCT], we assessed the value of both methods in combination for TxCAD monitoring.

Background: During the first post-transplant year, rejection surveillance is extensively based on routine endomyocardial biopsy (EMB) screenings. Nevertheless, routine EMBs are distressing to the patients and risky. We compared the diagnostic efficiency of routine biopsies with that of a combined, mainly non-invasive rejection surveillance strategy, in which EMBs were performed optionally, only in patients suspected for rejection. Methods: Two groups of heart recipients underwent different rejection surveillance strategies during their first post-transplant year. In group A (n =76) we performed telemetric monitoring of the intramyocardial electrogram (IMEG) from a dual-chamber pacemaker. Overnight IMEG changes were analyzed on daily printouts. Additional pulsed-wave tissue Doppler (PW-TD) wall motion analyses were performed daily during hospitalization and, after discharge, at each ambulatory examination. In group B (n =22), in addition to IMEG recordings and PW-TDI examinations, routine EMB screenings were performed at predefined time intervals.

Background: We assessed the left ventricular (LV) function and exercise tolerance in non-rejecting heart recipients, in connection with post-transplant time, amount of interstitial fibrosis and presence of transplant coronary artery disease (TxCAD).

Mueller, J; Kaufmann, F; Wenig, Y; Dandel, M; Pasic, P; Loebe, M; Hummel, M; Bettmann M, M; Bieda, H; Hetzer, R