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

Role of paediatric assist device in bridge to transplant

“…The group believed that elimination of RV dysfunction completely decreases postoperative bleeding, secondary to improved liver function, limits renal dysfunction, and allows earlier extubation, thus enabling earlier intensive care unit discharge and enhanced mobilization. Support for this strategy originated from previous adult VAD experience (38)(39)(40)(41). These studies suggested that apparently poorer outcomes with biventricular support were confounded by patients who primarily underwent LVAD implantation, later followed by right VAD implantation due to onset of RV failure.…”

Heart Replacement Therapy: Biological, Mechanical or Regenerative?

“…For this reason, heart transplantation was almost universally abandoned for at least a decade. The US and non‐US governments redirected their research funds toward the development of an implantable LVAD, not as a bridge to transplantation but as a permanently implantable device . Cyclosporine was introduced which dramatically expanded the use of heart transplantation and made bridging patients to transplant feasible .…”

“…However, they were too large to fit in smaller patients, including many women and children. Perhaps even more importantly, the durability of these pumps was limited .…”

“…Roland Hetzer and DeBakey in 1998 and then of the Jarvik Heart in 2000, followed by the HeartMate II in 2003 at THI by Dr. O.H. Frazier ultimately resulted in thousands of pumps implanted and lives saved by several dedicated centers .…”

“…However, despite all encouraging results of technology evolution and the current knowledge/management of induced mechanical circulatory support physiology, as above mentioned, the Achilles' heel of implantable mechanical circulatory support devices still remains the absence of a satisfactory biocompatibility with consequent thromboembolic events and the presence of a percutaneous driveline which leads to high risk of infective disorders and represents a real barrier to the long‐term application of VADs and TAHs in terms of definitive therapies .…”