First Turkish experience with the MicroMed DeBakey VAD

Mechanical bridging to cardiac transplantation with a ventricular assist device may be a life-saving procedure for patients with end-stage heart failure. Here we report our 3 cases of patients implanted with the MicroMed DeBakey VAD (ventricular assist device). Three male patients, aged 37, 41, and 40, had end-stage left heart failure due to idiopathic cardiomyopathy and were listed for cardiac transplantation. They had progressive hemodynamic deterioration. Although Patient 1 underwent surgery, after device implantation, for bowel necrosis caused by thromboemboli of unknown origin, heart transplantation was performed 70 days after implantation. Pump thrombosis occurred in Patient 2 on the 120th day. Outflow graft ligation was performed because the patient refused a pump exchange. This patient died on the 25th day after ligation and the 145th day after ventricular assist device implantation. A heparin-coated version of the device was implanted in Patient 3, whose preoperative profound biventricular failure had been improved by inotropic medication and intra-aortic balloon pump support. Successful heart transplantation was performed 161 days after implantation. These are the 1st implantations of a left ventricular assist device in Turkey. From these cases, we have learned that the DeBakey VAD supplies adequate blood flow during the bridging period and, due to its simplicity, portability, and low infection rate, enables discharge of the patient from the hospital. However, preoperative psychological evaluation and postoperative psychological support are important for a successful bridging procedure, as is close observation of coagulation and of pump operation.