Rotary Blood Pumps as Long-Term Mechanical Circulatory Support: A Review of a 15-Year Berlin Experience

• Published in: Seminars in thoracic and cardiovascular surgery 2016, Vol.28 (1), p.12-23
• Main Authors: Hetzer, Roland, MD, PhD, Kaufmann, Friedrich, Potapov, Evgenij, MD, PhD, Krabatsch, Thomas, MD, PhD, Delmo Walter, Eva Maria, MD, MSc, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Cardiothoracic Surgery; Child; Child, Preschool; Comorbidity; Device Removal; Female; Germany; heart failure; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Heart Transplantation; Heart-Assist Devices; Hemodynamics; Humans; Male; mechanical circulatory support; Middle Aged; Patient Selection; Platelet Aggregation Inhibitors - therapeutic use; Prosthesis Design; Prosthesis Failure; Recovery of Function; Risk Factors; rotary blood pumps; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors; Treatment Outcome; ventricular assist device; Ventricular Function, Left; Ventricular Function, Right; Young Adult
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2016.01.001

Objective This paper reports our 15-year single-center experience with rotary blood pumps (RBPs) as long-term mechanical circulatory support with emphasis on outcomes. Methods For over a 15-year period, we have used various RBPs as bridge to transplantation or to myocardial recovery. Our group performed the first human implantation worldwide of a rotary blood pump, the MicroMed DeBakey VAD in November 1998 in a patient with end-stage heart failure who was supported for 47 days until his death. Based on this initial experience we recognized the feasibility of providing long-term support and since then it has been our primary armamentarium in treating heart failure patients. Results Between 1987 and September 2013, we have implanted 2208 ventricular assist devices ranging from pulsatile to continuous flow systems, as short-term, long-term or permanent support in patients with end-stage heart failure. 1009 RBPs were implanted on 908 patients and their outcomes are reported here. We have shared some milestones in MCS including the first implantation of Jarvik 2000 on the oldest patient (81 years old) in 2008 and the first worldwide implantation of a biventricular HeartWare. Over time, implantation techniques, anticoagulation and postoperative care have been modified and individualized. A relevant aspect of our experience has been the incidence of pump thrombosis. This is particularly frustrating because the problem has occurred in the setting of full anticoagulation and antiplatelet therapy, guided by strict anticoagulation monitoring. It has become clear to us that the devices are still not perfect. Technical pump failures such as cable breaks also occur, prompting urgent pump exchange, and infection. Fifteen-year cumulative mortality rate is 46.9%. Conclusion This report emphasizes that MCS with RBPs has evolved into a routine treatment in heart failure and is a highly feasible option for permanent therapy particularly for elderly patients.