[Left monoventricular assistance with DeBakey VAD continuous flow pump: initial clinical Italian experience]

The shortage of heart donors causes a rise in mortality among candidates for cardiac transplantation and increases the waiting list. Consequently mechanical circulatory support for bridge to transplant is now a standard clinical procedure utilized in the most representative cardiac surgery centers. Recently, continuous-axial-flow pumps have been introduced in the clinical practice and have led to new perspectives.

Four patients suffering from end-stage heart failure were implanted with a DeBakey ventricular assist device (VAD) continuous-flow pump as a bridge to heart transplant. The DeBakey VAD is smaller than the pulsatile devices commonly employed, the pump is totally implantable and is connected to a small controller and two batteries by a transcutaneous drive line.

One patient died of multiorgan failure during assistance; 3 patients were fully rehabilitated and were successfully transplanted after 55, 42 and 141 days respectively. In the early postoperative period the mean pump flow was 4.27 +/- 0.55 l/min, after 1 week of assistance the flow rose to 5.32 +/- 0.57 l/min and then progressively increased to 5.83 +/- 0.57 l/min.

This experience demonstrated the possibility of continuous-flow left ventricular support with the DeBakey VAD for mid-term mechanical ventricular assistance. This pump presents new interesting aspects and opens new perspectives for the future of left ventricular mechanical assistance. Increasing experience will define the role of this device in the scenario of heart failure.