Destination left ventricular assist devices in island states: asking too much or the inevitable solution

Abstract

Background Destination left ventricular assist device placement is increasing as a result of donor shortages and changing patient attitudes. As organ shortages become critical, LVAD programs become fundamental even in more remote regions of the world including island states. Here, we provide a look into the current state and availability of LVAD programs in island states. Main body A narrative review was performed using the World Health Organization Global Index Medicus and PubMed/MEDLINE databases to identify articles describing the island states having reported LVAD placements and programs. Additionally, INTERMACS reports were used. Data were retrieved and a review is presented describing the current state of LVADs in island states. The Caribbean region as a whole has a heart failure (HF) prevalence of 814 per 100,000 and Oceania 667 per 100,000 people. We estimate that over 3000 people in these islands need either a heart transplant or an LVAD. Short conclusion For HF patients living in island regions, special attention should be paid to the inability of having access to specialized mainland medical care. The continuous quest for a solution to HF in island regions should include the establishing of high-quality LVAD programs in a transfer-network centralized/regionalized system to care for those patients not candidates for long-distance air-bridging.

Bench bioprosthetic aortic valve replacement in a donor heart before transplantation

“…[3][4][5] Although options such as left ventricular assist devices, extra-corporeal membrane oxygenation, and artificial hearts are all acceptable treatment modalities, the superior benefits of orthotopic cardiac grafts remain clear. [3][4][5] Additionally, the use of bioprosthesis instead of a mechanical valve in patients warranting replacement offers the benefit of avoiding warfarin use which will increase complications of serial biopsies following transplantation and increase pharmacologic interactions with immunosuppression medications. [1][2][3] In emerging countries such as Colombia, pre graft harvesting echocardiography is not always available and many graft abnormalities can only be seen during harvesting or at bench examination.…”

“…[1][2][3] In emerging countries such as Colombia, pre graft harvesting echocardiography is not always available and many graft abnormalities can only be seen during harvesting or at bench examination. 4,5 Therefore, optimizing graft usage and expanding the availability of useful marginal hearts with either valve repair or replacement in donor hearts may offer an excellent option to provide recipients with an opportune solution. [1][2][3]…”

“…As organ shortages increase along with increasing number of heart failure patients, alternative methods to ensure end‐stage heart failure treatment become critical 3–5 . Although options such as left ventricular assist devices, extra‐corporeal membrane oxygenation, and artificial hearts are all acceptable treatment modalities, the superior benefits of orthotopic cardiac grafts remain clear 3–5 .…”

“…As organ shortages increase along with increasing number of heart failure patients, alternative methods to ensure end‐stage heart failure treatment become critical 3–5 . Although options such as left ventricular assist devices, extra‐corporeal membrane oxygenation, and artificial hearts are all acceptable treatment modalities, the superior benefits of orthotopic cardiac grafts remain clear 3–5 . Additionally, the use of bioprosthesis instead of a mechanical valve in patients warranting replacement offers the benefit of avoiding warfarin use which will increase complications of serial biopsies following transplantation and increase pharmacologic interactions with immunosuppression medications 1–3 …”

Thirty-five Years of Heart Transplantation in Medellín: Colombia’s First Center for Cardiac Transplantation

“…Heart failure in Colombia affects 854.6 per 100 000 people and the burden of years lived with disability reaches 118.3 out of 100 000 people. 1,2 Heart failure represents a significant cause for diminished quality of life for both patients and families while adding a considerable financial burden to healthcare. On December 1, 1985, the first heart transplant in Colombia was performed at the Clínica Cardiovascular Santa María (today Clínica Cardio VID ) in Medellín, Colombia, by Alberto Villegas Hernández.…”