Significant reduction in major LVAD device failures: comparison of the heartmate® VE and XVE LVAS

Abstract

Background: Left ventricular assist device (LVAD) is an established surgical therapy for patients with end-stage heart failure (HF) as a bridge to heart transplantation (HTx). Pulsatile LVAD clinical application is limited by large dimensions, noise and major complications as bleeding, thromboembolism and infection. We report our clinical experiences with the DeBakey VAD continuous axial flow pump as bridge to HTx (BTT). Patients and Methods: Since April 2000, 12 patients with end-stage HF have been supported with the DeBakey VAD at our Institution (8 male, 42 14 years, range 12-57 y; 8 dilated idiopathic cardiomyopathy, 3 ischemic cardiomyopathy, 1 for major device failure of a pulsatile LVAD implanted at another institution). Before implant all patients suffered for severe heart failure (NYHA IV) despite of maximal pharmacological support and were put on the waiting list for HTx. All patients signed written informed consent. Mean cardiac index was 1,58 0,52 l/min/m2. Results: Total support time amounts to 607 patient/days. Nine patients (75%) were successfully transplanted after 51 49 days (range 11 -141 days). Two patients (16.6%) died during assistance due to multiorgan failure. One patient is still on VAD. No patients needed right-VAD. Bleeding complications required rethoracotomy in 2 patients (16.6%), neurologic event occurred in 1 patient, left ventricle/LVAD thrombosis occurred in one patient and was succesfully conservatively treated with endoventricular thrombolysis delivering rTPA into the left ventricle. No clinically relevant elevation of plasma-free hemoglobin was detected. No device, driveline or abdominal pocket infection occurred. No device failure occurred. Conclusions: In our clinical experience the axial continuous flow DeBakey VAD obtained an elevated rate of success associated with low risk for bleeding, hemolysis, thromboembolic and infectious complications.