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Dieter Hammel
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J Thorac Cardiovasc Surg 2005;130:1122-1129
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Long-term support of 9 patients with the DeBakey VAD for more than 200 days

Markus J. Wilhelm, MD a , * , Dieter Hammel, MD a , Christof Schmid, MD a , Andreas Rhode, MS a , Timo Kaan, MS a , Markus Rothenburger, MD a , Jörg Stypmann, MD b , Michael Schäfers, MD c , Christoph Schmidt, MD d , Hideo A. Baba, MD e , Hans H. Scheld, MD a

a Department of Thoracic and Cardiovascular Surgery, Westfalian Wilhelms-University, Muenster, Germany
b Department of Cardiology and Angiology, Westfalian Wilhelms-University, Muenster, Germany
c Department of Nuclear Medicine, Westfalian Wilhelms-University, Muenster, Germany
d Institute of Anesthesiology and Operative Intensive Care, Westfalian Wilhelms-University, Muenster, Germany
e Institute of Pathology, Westfalian Wilhelms-University, Muenster, Germany

Received for publication May 14, 2004; revisions received September 23, 2004; accepted for publication October 22, 2004.

* Address for reprints: Markus J. Wilhelm, MD, Department of Cardiovascular Surgery, University Hospital Zurich, Raemistr 100, CH 8091 Zurich, Switzerland (Email: markus.wilhelm{at}swissonline.ch).

OBJECTIVE: Pulsatile left ventricular assist devices serving as mechanical circulatory support for patients with end-stage heart failure are associated with complications, including bleeding, thromboembolism, and infection. Axial-flow pumps might overcome some of these shortcomings. Here we report our experience with long-term application of the DeBakey VAD (MicroMed Technology, Inc, Houston, Tex).

METHODS: Nine male transplant candidates (37 ± 14 years) with severe hemodynamic compromise (cardiac index, 1.6 ± 0.5 L · min–1 · m–2; pulmonary capillary wedge pressure, 27 ± 6 mm Hg) and beginning end-organ failure despite inotropic and intra-aortic balloon pump support received the DeBakey VAD. Clinical outcome was evaluated.

RESULTS: Cumulative support was 7.8 years, and the mean duration of support was 314 ± 75 days (range, 229-438 days). Eight patients were transplanted, and one died from intracerebral bleeding. Peripheral circulation and end-organ function recovered rapidly after implantation. Continuous flow was able to maintain adequate organ perfusion over the long term. Eight patients were discharged during support, with good quality of life. There were no early bleedings, but there were late bleedings in 3 patients caused by excessive anticoagulation and platelet inhibition. Neurologic events occurred in 4 patients. Three patients recovered completely from symptoms, and one had lethal intracerebral bleeding. Because of thrombus formation, the device was exchanged in 4 patients. With increasing experience, thrombolysis was performed in similar situations. All such patients underwent successful transplantation. Hemolysis occurred, with events indicating thrombus formation. Device-related infection was found in one patient.

CONCLUSIONS: The DeBakey VAD demonstrated its potential for long-term bridge to transplantation. The risk for thrombus formation needs to be addressed by improvement of pump technology and new strategies for platelet inhibition.

18; 22; 27




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