Initial results of clinical trial with a new left ventricular assist device (LVAD) providing synchronous pulsatile flow.
OBJECTIVE
A multicentric European Clinical Study is ongoing to evaluate safety and efficacy of a new pulsatile implantable LVAD (BestBeat), smaller and lighter than similar devices, capable of providing synchronous and counterpulsating flow with respect to the LV of end-stage heart failure patients. Preliminary clinical results are reported.


METHODS
The new BestBeat LVAD was used, consisting of an implantable pulsatile blood pump, electromechanically driven by a ball screw mechanism, and a wearable electronic controller and power sources. The clinical trial was conducted at 5 european centers. Adult patients affected by CHF in NYHA Class IV despite optimized medical treatment were enrolled. The primary study endpoint was survival at 90 days. Further study endpoints were maintenance of adequate LVAD pump flow and a minimum rate of adverse events during support.


RESULTS
As of June 2008, 6 patients received the implant. Cumulative support time was 3.7 years, median support time 176 days. All patients who completed the study survived except for one, who died after 48 days, due to combined infection and cerebrovascular accident. Another two patients died: one from intracranial bleeding 113 days after implant, and one from septic shock after 123 days. Hemodynamic improvement with CI>2.0 l/min/m2 and recovery of end-organ function expressed by consistent improvement of BUN, creatinine and bilirubin were reached in all patients. No device failure was observed. There was no bleeding requiring re-exploration, no hemolysis and only two device-related infections (both in one patient). Neurologic events were reported, the most serious ones occurring in patients with pre-implant respiratory and kidney failure. Three patients were discharged home. Two patients were successfully transplanted, one after 6 months and one after 13 months on device.


CONCLUSIONS
Good performance and efficacy of the device were observed; the endpoints of the study were achieved, and its safety was consistent with expectations. The ongoing study will allow further conclusions to be drawn.
Gazzoli
Fabrizio
F
Heart Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. f.gazzoli@smatteo.pv.it
Viganò
Mario
M
Pagani
Francesco
F
Alloni
Alessia
A
Silvaggio
Giuseppe
G
Panzavolta
Marco
M
El Banayosy
Aly
A
Koerfer
Reiner
R
Morshuis
Michiel
M
Pavie
Alain
A
Leprince
Pascal
P
Glauber
Mattia
M
Del Sarto
Paolo
P
Haxhademi
Dorela
D
Vitali
Ettore
E
Russo
Claudio F
CF
Scuri
Silvia
S
D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D003401:Creatine / Q000097:blood; D004867:Equipment Design; D005060:Europe; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011673:Pulsatile Flow; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D003401:Creatine; D001663:Bilirubin