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Outcomes of Biventricular Mechanical Support Patients Discharged to Home to Await Heart Transplantation

Creaser, Julie W. RN, MN; Rourke, Darlene RN, MSN; Vandenbogaart, Elizabeth RN, MSN; Chaker, Tamara RN, MSN; Nsair, Ali MD; Cheng, Richard MD; Fonarow, Gregg MD; Livingston, Nancy RN, MN; Howell, Elan RN, BSN; Huie, Newman RN, BSN; Baas, Arnold S. MD; Deng, Mario MD; Hickey, Ann MD; Shemin, Richard J. MD; MacLellan, W. Robb MD

Journal of Cardiovascular Nursing:
doi: 10.1097/JCN.0000000000000168
Articles: Online Only
Abstract

Background: The use of left ventricular assist devices has grown rapidly in recent years for patients with end-stage heart failure. A significant proportion of patients require both left- and right-sided support with biventricular assist devices (BiVADs) as a bridge to transplantation. Traditionally, these patients have waited in the hospital until they receive a transplant.

Purpose: The aim of this study was to characterize the clinical course of BiVAD patients discharged to home to await heart transplantation.

Methods: Between November 2009 and July 2011, 24 adult patients underwent Thoratec paracorporeal BiVAD placement at the University of California Los Angeles, all with an Interagency Registry for Mechanically Assisted Circulatory Support score 1 or 2. The disposition, complications, and rehospitalizations of these subjects were retrospectively reviewed.

Results: Fourteen of the 24 patients were successfully discharged to home, with a mean time of 60 ± 27 days from BiVAD implantation to discharge. Ninety-three percent (13/14) of the patients sent home went on to be transplanted. Eleven of the 14 (79%) came in from home to receive their transplant. The mean time from BiVAD implantation to transplantation was 100 ± 65 days. Of the 14 patients discharged to home, there were 18 readmissions in 8 patients.

Conclusion: In this small single-center review, we found that complex medical patients with BiVADs can be discharged to home and can await a heart transplant from home under the close management of multidisciplinary acute care and outpatient teams.

Author Information

Julie W. Creaser, RN, MN Clinical Nurse Specialist, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Darlene Rourke, RN, MSN Clinical Nurse Specialist, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Elizabeth Vandenbogaart, RN, MSN Nurse Practitioner, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Tamara Chaker, RN, MSN Nurse Practitioner, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Ali Nsair, MD Assistant Professor, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Richard Cheng, MD Clinical Instructor, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Gregg Fonarow, MD Professor of Medicine, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Nancy Livingston, RN, MN Nurse Practitioner, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Elan Howell, RN, BSN VAD Coordinator, Department of Transplant Services, University of California Los Angeles.

Newman Huie, RN, BSN VAD Coordinator, Department of Transplant Services, University of California Los Angeles.

Arnold S. Baas, MD Associate Professor, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Mario Deng, MD Professor of Medicine, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Ann Hickey, MD Assistant Professor, Department of Medicine, Division of Cardiology, University of California Los Angeles.

Richard J. Shemin, MD Chief of Cardiothoracic Surgery, Department of Surgery, Division of Cardiothoracic Surgery, University of California Los Angeles.

W. Robb MacLellan, MD Professor, Head of Cardiology, Department of Medicine, Division of Cardiology, University of Washington, Seattle.

The authors have no funding or conflicts of interest to disclose.

Correspondence Julie W. Creaser, RN, MN, Ahmanson-UCLA Cardiomyopathy Center Ronald Reagan UCLA Medical Center 100 Medical Plaza, Ste 630E, Los Angeles, CA 90095 (jcreaser@mednet.ucla.edu).

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