LVAD coordinator effects on outcomes in patients undergoing LVAD implantation: The Methodist DeBakey Heart Center experience
Background: Use of left ventricular assist devices (LVAD) for support of endstage heart failure patients as a bridge to cardiac transplantation creates opportunities both for improved patient survival rate and for lower peri-operative complications. We investigated the effect on patient outcomes and incidence of complication of assigning an LVAD coordinator for heightened clinical monitoring and patient management in this population. Methods: Between June 2000 and January 2002, 28 patients with terminal heart failure underwent LVAD implantation, 14 patients prior to LVAD-coordinator employment and 14 patients under supervision of the LVAD coordinator. Patients' records were retrospectively analyzed for incidence of infection, life-threatening thromboembolic and bleeding events, and hospital charges. Results: In the pre-coordinator group, two patients were discharged home while on LVAD support. Seven patients (50%) developed infections requiring antibiotic treatment; five patients (35%) had severe life-threatening thromboembolic events. Six patients were transplanted and eight patients died while on LVAD support, giving an overall survival of 42% in this group. In the post-coordinator group, seven patients were discharged home while on LVAD support. Four patients developed infections, one patient had a severe life-threatening thromboembolic event. Ten patients were successfully transplanted, one patient is currently supported on the device, and 3 patients died, for an overall survival of 78% in this group. Conclusion: The use of a fulltime professional coordinator has had a beneficial impact on patient outcomes. Patient survival was improved, device-related complications were reduced and eligible patients could be discharged safely from the hospital.