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Hemodynamic performance and inflammatory response during the use of VAD-InCor as a bridge to transplant
João Galantier1, Luiz Felipe P Moreira, Anderson Benício
1Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. galantier@terra.com.br
Insights
The InCor-type ventricular assist device (VAD-InCor) provided adequate hemodynamic support for patients awaiting heart transplantation. While complications occurred, the device demonstrated safe performance for bridging to transplant.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
- Transplantation Medicine
Background:
- Limited donor availability for cardiac transplantation leads to high mortality rates.
- Mechanical circulatory assist devices offer a survival option for patients awaiting heart transplants.
- Brazil has limited experience and no established program for mechanical circulatory support as a bridge to transplantation.
Purpose of the Study:
- To evaluate the hemodynamic performance of the InCor-type ventricular assist device (VAD-InCor).
- To assess the systemic inflammatory response during VAD-InCor use.
- To determine the efficacy of VAD-InCor as a bridge to heart transplantation.
Main Methods:
- Seven patients with refractory cardiogenic shock awaiting heart transplantation received VAD-InCor implantation.
- Patients had diagnoses of Chagas' disease (5) or idiopathic dilated cardiomyopathy (2).
- Hemodynamic performance and inflammatory markers were monitored during left ventricular assistance.
Main Results:
- Left ventricular assistance duration averaged 26.2 days (range 14-42 days).
- VAD-InCor maintained adequate hemodynamic support, normalizing central venous oxygen saturation and serum lactate.
- Two patients successfully underwent heart transplantation; five died from infection and multiple organ failure.
Conclusions:
- VAD-InCor provided adequate hemodynamic support, improving tissue perfusion parameters.
- The device maintained systemic inflammatory response signs without demonstrating safety-compromising complications.
- Despite a high incidence of complications, the VAD-InCor showed adequate performance for bridging patients to heart transplantation.
Background:
Cardiac transplantation faces the serious problem of lack of donors and it is estimated that 20 to 40% of the patients die while waiting for heart transplantation. For these patients, the use of mechanical circulatory assist devices is the only choice of survival while waiting for a donor. In Brazil, the experience with mechanical circulatory support is limited and there is no regular program regarding the use of these devices as a bridge to heart transplantation.
Objective:
To evaluate the hemodynamic performance and the systemic inflammatory response during the clinical use of the InCor-type ventricular assist device (VAD-InCor) as a bridge to heart transplantation.
Methods:
Between October 2003 and April 2006, 11 patients in the waiting list for heart transplantation presented hemodynamic deterioration due to refractory cardiogenic shock. Seven of these patients were submitted to VAD-InCor implantation for left ventricular assistance. The etiologic diagnosis was Chagas' disease in 5 patients and idiopathic dilated cardiomyopathy in 2.
Results:
The duration of left ventricular assistance ranged from 14 to 42 days (mean 26.2 days). During this period, the hemodynamic performance of the DAV-InCor was adequate to support a normal hemodynamic state. There was normalization of central venous oxygen saturation and serum lactate. Two patients were submitted to heart transplantation, while the other 5 patients died under assistance due to infection and multiple organ failure.
Conclusion:
The performance of the VAD-InCor, in the hemodynamic behavior of the studied patients, was adequate for the maintenance of a satisfactory circulatory state during the studied period. There was improvement in the tissue perfusion parameters and maintenance of systemic inflammatory response signs. There was a high incidence of complications; however, complications related to the device, which could compromise the safety of its use, were not demonstrated.
