First clinical experience with the DeBakey VAD continuous-axial-flow pump for bridge to transplantation

Background-A shortage of donor organs and increased numbers of deaths of pa tients on the waiting list for cardiac transplantation make mechanical circ ulatory support for a bridge to transplantation a standard clinical procedu re. 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 now was 3.9+/-0.5 L/min, which equals a mean cardiac index (Cl) of 2.3+/-0.2 L.min(-1).m(-2). In both patients, the early postoperativ e phase was characterized by a completely nonpulsatile flow profile. Howeve r, with the recovery of heart function 8 to 12 days after implantation, inc reasing pulse pressures became evident, and net flow rose to 4.5+/-0.6 L/mi n, causing an increase of mean Cl up to 2.7+/-0.2 L.min(-1).m(-1). Patients were mobilized and put through regular physical training. Hemolysis stayed in the physiological range and increased only slightly fi om 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-transpl ant mechanical support.