Bridge to transplantation with the MicroMed DeBakey ventricular assist device axial pump: a single centre report.
OBJECTIVE
Left ventricular assist devices (VADs) are an accepted therapy to bridge patients with end-stage heart failure to heart transplantation. The DeBakey VAD, a continuous axial flow pump weighing 93 g, has been introduced into clinical practice as a bridge to transplant.


METHODS
Starting from April 2000,17 patients (12 males, five females, mean age 44.3 +/- 12.8 years; 11 dilated idiopathic cardiomyopathy, five ischaemic cardiomyopathy, one pulsatile device failure) with end-stage heart failure were implanted with a DeBakey VAD as a bridge to transplantation at our institution. Before implant, all patients suffered from severe heart failure (New York Heart Association functional class IV) despite optimal medical therapy and were put on the waiting list for heart transplantation. Mean cardiac index was 1.59 +/- 0.51 l/min/m2.


RESULTS
Fourteen patients were successfully transplanted after 99 +/- 117 days of assistance (range 11-443 days). Two patients died during assistance of multiorgan failure, one patient is still on VAD. No patient needed additional right ventricular mechanical support. Left ventricular/left VAD thrombosis occurred in one patient who was successfully treated conservatively. No clinical elevation of plasma free haemoglobin was detected. Neither device, driveline, abdominal pocket infection nor device failure occurred.


CONCLUSIONS
In our experience with the continuous axial flow DeBakey VAD, a high success rate was obtained associated with a low risk of complications. All the patients tolerated continuous blood flow for extended periods that makes this device a valuable alternative to pulsatile VADs as a bridge to transplantation.
Bruschi
Giuseppe
G
Department of Cardiac Surgery, A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
Ribera
Elena
E
Lanfranconi
Marco
M
Russo
Claudio
C
Colombo
Tiziano
T
Garatti
Andrea
A
Oliva
Fabrizio
F
Milazzo
Filippo
F
Frigerio
Maria
M
Vitali
Ettore
E
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D004867:Equipment Design; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation
D000925:Anticoagulants