Brazilian Unicentric Experience of Implanting Long-Term Ventricular Assist Devices

Purpose In the past 20 years, long term ventricular assist devices (LVAD) have become part of long-term therapy in patients with advanced heart failure (HF), with an increasing number of implants in worldwide. However, the implantation of LVAD for patients with advanced HF in Brazil requires high investment and specialized technical knowledge, which hinders the availability of this resource. We will analyse the outcomes as mortality, quality of life and complications of using LVAD in patients with advanced HF at a cardiology center in Brazil. Methods Data based on analysis of medical records with the clinical characteristics, outcomes and complications of patients who underwent LVAD implantation in the last 7 years, as well as mortality in 1 year and improvement in functional capacity. Results 23 LVAD (Berlin Heart INCOR®, Heart Mate II and Heart Mate III) were implanted in patients with advanced HF. 52% of the patients were male, with a mean age of 53 years, 39% had ischemic heart disease and 70% had INTERMACS 3. The mean left ventricular ejection fraction was 24%. Among the indications for implantation of LVAD, 65% were as destination therapy, 17% as a bridge for heart transplantation due to the expectation of long queuing time and 17% as a bridge for candidacy. The 1-year survival was 66% and after 6 months of LVAD, 95% were in NYHA I. The average length of stay with the device was 445 days and the maximum time was 1066 days. The main causes of death were hemorrhagic shock, right ventricle failure and stroke. Four patients underwent for LVAD explant, three of whom were transplanted. Of all cases, 83% were discharged from hospital, with an average hospital stay of 47 days after implantation. Conclusion Despite requiring high financial resource and notorious technical quality, this therapy is feasible in a country with high incidence of advanced HF, providing shorter hospital stays, high 1-year survival rate and significant improvement in quality of life.