0381: Heart failure and mechanical circulatory support: experience of a “medico-surgical unit “

With the shortage of grafts, mechanical circulatory support has emerged as an alternative to heart transplantation. This activity requires a multidisciplinary team specialized in the treatment of heart failure.This is a single-center prospective cohort of patients under long-term intracorporeal and continuous-flow left assist device type HeartMate II, between january 2008 and january 2014.Thirty-four devices were implanted in 30 men (88.2%) and 4 women (11.8%) with a mean age of 57.8 years. It concerned ischemic cardiomyopathy in 25 cases (73.5%) and primitive dilation in 9 cases (26.5%). The objective was a « destination therapy » in 11 patients (32.4%) and a « bridge-to-transplant » in 23 patients (67.6%). The 30-day mortality was 4 cases (11.8%), there were 11 deaths (32.4%) with a 1-year survival of 89.5%. Right ventricular failure, defined by a use of inhaled nitrogen monoxide > 48 hours and/or inotropes >14 days, appeared in 14 cases (41.2%). Associated factors were: young age, high pulmonary arterial resistances and right pressures, increased bilirubin and cavitary dilation. The mean duration of intubation was 5 days and ICU stay of 13.2 days. Initial suites were marked by 6 surgical re-openings for bleeding (17.6%), 5 acute renal failures requiring dialysis (14.7%) and 10 acute respiratory distresses (29.4%). Follow-up was performed in a dedicated unit, with functional, ultrasound and rythmological assessment, dietary and psycho-social support, and finally therapeutic education. The main late complications included 4 strokes (11.8%), ischemic or haemorragic, and 9 driveline infections (26.5%). Two patients were transplanted, two others are on waiting list.Thanks to close collaboration between cardiologists and surgeons, the management of patients with en-stage heart failure has improved with our growing experience in the field of long-term assistance