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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:727-35 - Vol. 70 Num.09 DOI: 10.1016/j.rec.2017.03.004

Experience With a Long-term Pulsatile Ventricular Assist Device as a Bridge to Heart Transplant in Adults

Manuel Gómez Bueno a,b,, Javier Segovia Cubero a,b, Santiago Serrano Fiz c, Juan Ugarte Basterrechea c, Francisco José Hernández Pérez a, Josebe Goirigolzarri Artaza a, Evaristo Castedo Mejuto c, Raúl Burgos Lázaro c, Carlos García Montero c, Vanessa Moñivas Palomero a, Susana Mingo Santos a, Ana Isabel González Román d, José Manuel Álvarez Avelló d, Mercedes Vidal Fernández d, Alberto Forteza Gil c, Luis Alonso-Pulpón a,b

a Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
c Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
d Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain

Keywords

Heart failure. Ventricular assist device. Heart transplant.

Abstract

Introduction and objectives

Most long-term ventricular assist devices (VADs) that are currently implanted are intracorporeal continuous-flow devices. Their main limitations include their high cost and inability to provide biventricular support. The aim of this study was to describe the results of using paracorporeal pulsatile-flow VADs as a bridge to transplant (BTT) in adult patients.

Methods

Retrospective analysis of the characteristics, complications, and outcomes of a single-center case series of consecutive patients treated with the EXCOR VAD as BTT between 2009 and 2015.

Results

During the study period, 25 VADs were implanted, 6 of them biventricular. Ventricular assist devices were indicated directly as a BTT in 12 patients and as a bridge to decision in 13 due to the presence of potentially reversible contraindications or chance of heart function recovery. Twenty patients (80%) were successfully bridged to heart transplant after a median of 112 days (range, 8-239). The main complications included infectious (52% of patients), neurological events (32%, half of them fatal), bleeding (28%), and VAD malfunction requiring component replacement (28%).

Conclusions

Eighty percent of patients with the EXCOR VAD as BTT achieved the goal after an average of almost 4 months of support. The most frequent complications were infectious, and the most severe were neurological. In our enivonment, the use of these pulsatile-flow VAD as BTT is a feasible strategy that obtains similar outcomes to those of intracorporeal continuous-flow devices.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved