Successful experience in bridging patients to heart transplantation with the MicroMed DeBakey ventricular assist device.
BACKGROUND
Pulsatile left ventricular assist devices are used with increasing frequency to bridge patients with end-stage heart failure to heart transplantation (HTx). Implantation of pulsatile devices is a cumbersome surgical procedure that is associated with major complications, such as bleeding, thromboembolism, and infection. Recently, a continuous axial flow left ventricular assist device (DeBakey ventricular assist device) has been introduced with the goal of reducing the incidence of major complications.


METHODS
We reviewed our experience with 11 patients who received a DeBakey ventricular assist device axial flow pump for bridge to HTx from April 2000 through November 2001.


RESULTS
Two patients (18.2%) died of multiple-organ failure while on left ventricular assist device support. Bleeding requiring thoracotomy occurred in 2 patients (18.2%). One patient had a minor neurologic event, and one patient developed left ventricular assist device thrombosis, which was successfully treated without pump exchange. Renal failure developed in 1 patient and hepatic dysfunction in 2 patients. There were no instances of right heart failure. No device, pocket, or drive-line infections occurred. Nine patients (9 of 11, 81.8%) had HTx within 51 +/- 49 days (range, 11 to 141 days) after left ventricular assist device implant. One patient died 29 days after HTx because of acute rejection.


CONCLUSIONS
The continuous axial flow DeBakey ventricular assist device had reliable features, including a high rate of bridge to HTx. This device had low complication and system failure rates. We consider the DeBakey ventricular assist device a favorable alternative to pulsatile heart assist devices as a bridge to HTx.
Vitali
Ettore
E
Department of Cardiac Surgery A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy. evitali@ospedale-niguarda.it
Lanfranconi
Marco
M
Ribera
Elena
E
Bruschi
Giuseppe
G
Colombo
Tiziano
T
Frigerio
Maria
M
Russo
Claudio
C
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D002648:Child; D005260:Female; D006333:Heart Failure / Q000209:etiology; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D051437:Renal Insufficiency / Q000209:etiology; D013927:Thrombosis
D000925:Anticoagulants