Bruschi Giuseppe, Ribera Elena, Lanfranconi Marco, Russo Claudio, Colombo Tiziano, Garatti Andrea, Oliva Fabrizio, Milazzo Filippo, Frigerio Maria, Vitali Ettore
Department of Cardiac Surgery, A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2006 Feb;7(2):114-8. doi: 10.2459/01.JCM.0000203847.52149.87.
Left ventricular assist devices (VADs) are an accepted therapy to bridge patients with end-stage heart failure to heart transplantation. The DeBakey VAD, a continuous axial flow pump weighing 93 g, has been introduced into clinical practice as a bridge to transplant.
Starting from April 2000,17 patients (12 males, five females, mean age 44.3 +/- 12.8 years; 11 dilated idiopathic cardiomyopathy, five ischaemic cardiomyopathy, one pulsatile device failure) with end-stage heart failure were implanted with a DeBakey VAD as a bridge to transplantation at our institution. Before implant, all patients suffered from severe heart failure (New York Heart Association functional class IV) despite optimal medical therapy and were put on the waiting list for heart transplantation. Mean cardiac index was 1.59 +/- 0.51 l/min/m2.
Fourteen patients were successfully transplanted after 99 +/- 117 days of assistance (range 11-443 days). Two patients died during assistance of multiorgan failure, one patient is still on VAD. No patient needed additional right ventricular mechanical support. Left ventricular/left VAD thrombosis occurred in one patient who was successfully treated conservatively. No clinical elevation of plasma free haemoglobin was detected. Neither device, driveline, abdominal pocket infection nor device failure occurred.
In our experience with the continuous axial flow DeBakey VAD, a high success rate was obtained associated with a low risk of complications. All the patients tolerated continuous blood flow for extended periods that makes this device a valuable alternative to pulsatile VADs as a bridge to transplantation.
左心室辅助装置（VADs）是一种被认可的治疗方法，用于将终末期心力衰竭患者过渡到心脏移植。德巴基VAD是一种连续轴流泵，重93克，已作为移植桥梁引入临床实践。
从2000年4月开始，我们机构对17例终末期心力衰竭患者（12例男性，5例女性，平均年龄44.3±12.8岁；11例扩张型特发性心肌病，5例缺血性心肌病，1例搏动性装置故障）植入德巴基VAD作为移植桥梁。植入前，所有患者尽管接受了最佳药物治疗，但仍患有严重心力衰竭（纽约心脏协会功能分级IV级），并被列入心脏移植等待名单。平均心脏指数为1.59±0.51升/分钟/平方米。
14例患者在接受99±117天（范围11 - 443天）的辅助后成功进行了移植。2例患者在辅助期间死于多器官功能衰竭，1例患者仍在使用VAD。没有患者需要额外的右心室机械支持。1例患者发生左心室/左VAD血栓形成，经保守治疗成功。未检测到血浆游离血红蛋白的临床升高。未发生装置、驱动线、腹部口袋感染或装置故障。
根据我们使用连续轴流德巴基VAD的经验，获得了高成功率且并发症风险低。所有患者都能长时间耐受连续血流，这使得该装置作为移植桥梁成为搏动性VAD的有价值替代品。
