Thorac Cardiovasc Surg 2014; 62 - OP24
DOI: 10.1055/s-0034-1367101

Driving with a drive-line: an evidence based approach of driving restriction after implantation of left ventricular assist device in end stage heart failure

H. A. Welp 1, A. Gottschalk 2, B. Ellger 2, M. Scherer 1, S. Martens 1, L. Eckardt 3, S. Klotz 4, G. Mönnig 3
  • 1Universitätsklinikum Münster, Thorax- Herz und Gefässchirurgie, Münster, Germany
  • 2Universitätsklinikum Münster, Anästhesie, Intensiv- und Schmerzmedizin, Münster, Germany
  • 3Universitätsklinikum Münster, Abteilung für Elektrophysiologie, Münster, Germany
  • 4UKSH Campus Lübeck, Herz- Thorax- und Gefäßchirurgie, Lübeck, Germany

Background: Although sudden incapacitation in patients treated with a left ventricular assist device (LVAD) is a known complication evidence is scarce to justify driving recommendations. The aim of the current study was to retrospectively analyse the incidence of incapacitation in these patients.

Method: A total of 285 consecutive recipients (230 male (80.7%); ischemic cardiomyopathy 50.9%; dilatative cardiomyopathy 40.0%) of a left ventricular assist device (LVAD) for acute or chronic heart failure at our institution between 1995 and 2011 were included (bridge to transplantation in 241 patients (84.6%), bridge to recovery in 24 patients (8.4%) and destination therapy in 20 patients (7.0%)). Patient's charts and data from the hospital information system were screened for events with the potential of a sudden loss of consciousness. According to the risk of harm (RH) formula the annual RH was calculated.

Results: Total duration of mechanical circulatory support with physical ability to drive was 48401 days. During this time span a total of 397 events with the potential for loss of consciousness occurred (equals 3% annual risk). According to the RH formula the overall calculated annual risk to other road users posed by 100,000 car driving patients with LVADs in a private manner was 0.67% and therefore far below the generally accepted threshold of 5% per 100,000 patients per year. This was observed for pulsatile (0.76%) as well as for continuous flow devices (0.61%) with no significant difference between the two groups.

For commercial driving the overall calculated annual RH was 14.69% and thereby exceeded the accepted limit of 1%. This was observed for pulsatile (16.96%) as well as for continuous flow devices (13.70%) with no significant difference between the two groups.

Conclusion: Based on this retrospective analysis, private driving should be possible for patients who are stable on LVAD therapy. Especially for destination therapy driving is an important marker for quality of life.