First clinical experience with the DeBakey VAD continuous-axial-flow pump for bridge to transplantation.
BACKGROUND
A shortage of donor organs and increased numbers of deaths of patients on the waiting list for cardiac transplantation make mechanical circulatory support for a bridge to transplantation a standard clinical procedure. Continuous-flow rotary blood pumps offer exciting new perspectives.


RESULTS
Two male patients (ages 44 and 65 years) suffering from end-stage left heart failure were implanted with a DeBakey VAD axial-flow pump for use as a bridge to transplant. In the initial postoperative period, the mean pump flow was 3.9+/-0.5 L/min, which equals a mean cardiac index (CI) of 2.3+/-0.2 L. min(-1). m(-2). In both patients, the early postoperative phase was characterized by a completely nonpulsatile flow profile. However, with the recovery of heart function 8 to 12 days after implantation, increasing pulse pressures became evident, and net flow rose to 4.5+/-0.6 L/min, causing an increase of mean CI up to 2.7+/-0.2 L. min(-1). m(-2). Patients were mobilized and put through regular physical training. Hemolysis stayed in the physiological range and increased only slightly from 2. 1+/-0.8 mg/dL before surgery to 3.3+/-1.8 mg/dL 6 weeks after implantation.


CONCLUSIONS
The first clinical implants of the DeBakey VAD axial-flow pump have demonstrated the device to be a promising measure of bridge-to-transplant mechanical support.
Wieselthaler
G M
GM
Department of Cardiothoracic Surgery, University of Vienna, Austria. georg.wieselthaler@akh-wien.ac.at
Schima
H
H
Hiesmayr
M
M
Pacher
R
R
Laufer
G
G
Noon
G P
GP
DeBakey
M
M
Wolner
E
E
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000628:therapy*; D004867:Equipment Design; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006461:Hemolysis; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000628:therapy; D014019:Tissue Donors / Q000600:supply & distribution