Related Experiment Videos
Bridge to transplantation with the DeBakey VAD axial pump: a single center report
J M Grinda1, C H Latremouille, P Chevalier
1Department of Cardiac Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. jean-michel.grinda@egp.ap-hop-paris.fr
Insights
The DeBakey Ventricular Assist Device (VAD) shows promise as a bridge to transplantation for heart failure patients. While reoperations were needed, the axial pump offers miniaturization and easier implantation for continuous flow support.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
- Heart Failure Management
Background:
- End-stage heart failure necessitates advanced therapies like mechanical circulatory support.
- The DeBakey Ventricular Assist Device (VAD) represents a novel axial pump design for cardiac support.
Purpose of the Study:
- To evaluate the clinical experience with the DeBakey VAD as a bridge to transplantation.
- To assess the feasibility, outcomes, and challenges associated with this continuous flow assist device.
Main Methods:
- Nine patients with advanced heart failure (NYHA class IV) received the DeBakey VAD as a bridge to transplantation.
- Implantation was performed via sternotomy under extracorporeal circulation on a beating heart.
- Pre-operative conditions included inotropic support, intra-aortic counterpulsation, and ventricular rhythm disorders.
Main Results:
- The mean support duration was 81 days, with five patients successfully transplanted.
- Eight reoperations were required, primarily for bleeding and device-related issues.
- Two patients experienced significant hemolysis; no device infections or dysfunctions were observed.
Conclusions:
- The DeBakey VAD demonstrates potential for continuous flow assistance, sparking renewed interest in axial pump technology.
- The device's miniaturization and simpler implantation technique appear promising for future applications in heart failure therapy.
Aims:
To report our experience with a left ventricular assist device axial pump as a bridge to transplantation: the DeBakey Ventricular Assist Device (VAD).
Methods:
From February 1999 to February 2002, nine patients (among which eight males), with a mean age of 47 years, all in NYHA functional class IV, were proposed for a bridge to transplantation with the DeBakey VAD. Five patients had primary dilated cardiomyopathy, four had ischemic cardiomyopathy. All the patients had inotropic support prior to the intervention (dobutamine with a mean dose of 12 mcg/kg per min), six had an intra-aortic counterpulsation, four presented ventricular rhythm disorders. Interventions were performed through sternotomy alone (no need for an abdominal pocket) under extra-corporeal circulation on beating heart (except in one patient suffering from an apical thrombosis for which cardioplegic arrest was performed) as followed: implantation of the apical inflow cannula, tunneling of the percutaneous cable, implantation of the outflow graft under aortic side clamping, starting of the DeBakey VAD during CPB weaning-off.
Results:
Mean support duration was 81+/-62 days (16-224 days). Eight reoperations were required (three for bleeding or cardiac tamponade, one for haemoperitoneum, one for aortic bifurcation thrombectomy, one for right ventricular assist device implantation, two for iterative replacements of the DeBakey VAD). A significant hemolysis was observed in two patients. No device infection or dysfunction were observed. Secondary recovery of a pulsed flow was observed either clinically or by Echo-Doppler in six patients. Five patients were transplanted, four died prior to transplantation (three from multi-organ failure on post-operative day 35, 16 and 50, respectively, and the last patient was found disconnected at day 109).
Conclusions:
The DeBakey VAD is at the origin of renewed interest for continuous flow assist devices. Still under evaluation, the advantages of miniaturization and facility of implantation of this new device seem to be promising.