Left ventricular assist device (LVAD) program in Chile: first successful experience in South America

Pedemonte, Oneglio; Vera, Andrés; Merello, Lorenzo; Novajas, Manuel; Aranda, Fernando; Ibarra, Julio; Muñoz, José Antonio Costa; Alburquerque, Javier; Espinoza, Paulina Sánchez; Cárdenas, Felipe; Aránguiz-Santander, Ernesto

doi:10.21037/jtd.2018.02.83

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Although hard to quantify, our increase in LVAD coordinator bandwidth significantly improved our ability to build the volume of the program while maintaining its quality. Similar to our experience, previous reports have emphasized the need for team collaboration, highlighting the roles of cardiology, surgery, anesthesiology, critical care, nursing, LVAD coordinators, and social work 24,35–40 …”

Section: Discussionsupporting

confidence: 85%

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Development of a non‐transplant left ventricular assist device program

George

Aldrich

Smith

et al. 2022

Journal of Cardiac Surgery

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Introduction: Although the established long-term benefit of left ventricular assist device (LVAD) therapy has led to its proliferation as destination therapy (DT), few studies have evaluated LVAD outcomes at nontransplant centers. We undertook this study to better evaluate our experience in building a nontransplant, DT LVAD program.Methods: We conducted a retrospective review of all LVADs implanted from 2010 to 2021. Patient, operative, and outcome data were extracted from the electronic medical record. Secular trends were evaluated by organizing the data into eras of implant. Survival was assessed using the Kaplan-Meier method. Multivariable Cox proportional hazards regression models further evaluated outcomes.Results: From 2010 to 2021, 100 primary LVAD implants were performed. Annual volume grew from 1 to 30 implants per year. The average age of our cohort was 65.7 years, most patients (80%) were male, 51% had an ischemic etiology, and 65 (65%) were INTERMACS profile 1 or 2. Our 1-and 2-year survival were 82% and 79%, respectively. Multivariable analysis of 1-year mortality demonstrated that decreasing renal function and increased cardiopulmonary bypass (CPB) time were associated with increased mortality while preoperative hemoglobin was protective. When stratified by era of implant, our most recent patients were more likely to be INTERMACS profile 1 or 2; had shorter CPB and aortic cross clamp times; required fewer reoperations for bleeding; and suffered less right ventricular failure requiring mechanical support.Conclusions: A single, nontransplant LVAD center can experience significant growth in volume in a high-acuity cohort while maintaining acceptable outcomes and quality of care.

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Section: Discussionsupporting

confidence: 85%

“…Similar to our experience, previous reports have emphasized the need for team collaboration, highlighting the roles of cardiology, surgery, anesthesiology, critical care, nursing, LVAD coordinators, and social work. 24,[35][36][37][38][39][40]…”

Section: Transplant Versus Nontransplant Centersmentioning

confidence: 99%

Development of a non‐transplant left ventricular assist device program

George

Aldrich

Smith

et al. 2022

Journal of Cardiac Surgery

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“…By depicting the set-up of our program, we sought to provide practical elements for similar-sized centers wishing to implement a mechanical-circulatory-support program for DT. To our knowledge, only a few center's experience of establishing an LVAD-program are available with long-term results in the literature, and none specifically for DT [16][17][18][19][20][21]. Those available with long-term results usually concerned older-generation devices with different implantation strategies from those in our study (i.e.…”

Section: Discussionmentioning

confidence: 89%

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

Schaeffer

Pfister

Mork

et al. 2021

J Cardiothorac Surg

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Background In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel. Methods We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data. Results Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively. Conclusions The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial. Trial registration This study was registered on the ClinicalTrials.gov database (NCT04263012).

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“…This issue highlights some of the initial experiences of VAD implantation programs which have been developed to address the needs of diverse patient populations. These include studies by Nestorovic et al, Pedemonte et al and Tarazi et al who have documented initial experiences with LVAD implantation in Serbia, Chile and Kuwait respectively (22)(23)(24).…”

Section: The Evolution Of Mechanical Circulatory Support (Mcs): a Newmentioning

confidence: 99%

The evolution of mechanical circulatory support (MCS): a new wave of developments in MCS and heart failure treatment

Chatterjee

Schmitto

2018

J. Thorac. Dis.

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Cardiovascular diseases and heart failure (HF) remain one of the major causes of worldwide mortality. According to the American Heart Association, 85.6 million adults in the US suffer from cardiovascular diseases, out of which 5.7 million are living with HF (1). Decades of dedicated efforts on clinical as well as technological aspects of mechanical circulatory support (MCS) devices have led to their widespread success and acceptance for the treatment of advanced HF. Ventricular assist devices are key players in the MCS field. Left ventricular assist devices (LVADs) are a promising treatment option for HF due to the dearth of available donor organs for cardiac transplantation, despite the increasing number of patients on waiting lists (2). As per the annual INTERMACS reports, over 13,000 patients in the US received LVAD support in 2014 (3). Long-term follow-up studies of the newest generation of LVADs, including the HeartMate 3 (Abbott, North Chicago, IL, USA) and jtd.amegroups.com

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Left ventricular assist device (LVAD) program in Chile: first successful experience in South America

Cited by 6 publications

References 22 publications

Development of a non‐transplant left ventricular assist device program

Development of a non‐transplant left ventricular assist device program

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

The evolution of mechanical circulatory support (MCS): a new wave of developments in MCS and heart failure treatment

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