First Clinical Experience With the DeBakey VAD Continuous-Axial-Flow Pump for Bridge to Transplantation

Abstract

Background —A shortage of donor organs and increased numbers of deaths of patients on the waiting list for cardiac transplantation make mechanical circulatory support for a bridge to transplantation a standard clinical procedure. Continuous-flow rotary blood pumps offer exciting new perspectives. Methods and Results —Two male patients (ages 44 and 65 years) suffering from end-stage left heart failure were implanted with a DeBakey VAD axial-flow pump for use as a bridge to transplant. In the initial postoperative period, the mean pump flow was 3.9±0.5 L/min, which equals a mean cardiac index (CI) of 2.3±0.2 L · min −1 · m −2 . In both patients, the early postoperative phase was characterized by a completely nonpulsatile flow profile. However, with the recovery of heart function 8 to 12 days after implantation, increasing pulse pressures became evident, and net flow rose to 4.5±0.6 L/min, causing an increase of mean CI up to 2.7±0.2 L · min −1 · m −2 . Patients were mobilized and put through regular physical training. Hemolysis stayed in the physiological range and increased only slightly from 2.1±0.8 mg/dL before surgery to 3.3±1.8 mg/dL 6 weeks after implantation. Conclusions —The first clinical implants of the DeBakey VAD axial-flow pump have demonstrated the device to be a promising measure of bridge-to-transplant mechanical support.