Cardiovascular Journal of Africa: Vol 27 No 4 (July/August 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016

212

AFRICA

States Food and Drug Administration (FDA) and Conformit

Europ

enne (CE), and have been on the market for a long time.

Many centres have implanted these pumps in their end-stage

heart failure patients all over the world.

Long-term outcomes of these pumps have been published

recently in the literature.

1-13

Frazier

et al.

demonstrated the

modified Micromed axial flow pump has an

in vitro

responsivity

approaching that of the natural heart.

Bluestein

et al

. reported

that the thrombogenicity of Heart Assist 5 was 2.5-fold lower

than the HeartMate II LVAD.

Although our experience with Heart Assist 5 LVAD was not

from a large series, compared with other continuous-flow and

centrifugal pumps that we have implanted in our clinic, we tried

to standardise pre-operative LVAD evaluations and post-implant

follow up of LVAD patients in collaboration with the heart

failure cardiologists. We believe that as a heart failure/transplant

team, a systematic approach for the evaluation of these patients

suffering from advanced heart failure is important. Close follow

up of these patients will affect the success of LVAD surgery

and long-term prognosis of the patients, which will lessen the

side effects and enable rapid and accurate identification of

mechanical and systemic malfunctions.

Our group was the first to implant this version of Heart

Assist 5 LVAD in Turkey. An earlier version of this pump was

implanted in Turkey in April 2001.

There were no data in the

literature on the Heart Assist 5 LVAD using echocardiographic

parameters and LVAD optimisation protocols during long-term

follow up of the patients. In our clinical studies we were able

to visualise the inflow cannula and outflow graft anastomoses

to the aorta in most of the echocardiographic studies. The

remote monitoring system and the implantable flow probe

measurements were reliable, and tracking and monitoring of

these patients outside of hospital was easy.

Our study has limitations since there were so few patients with

Heart Assist 5 LVAD support in our group. However, if other

centres start implanting Heart Assist 5 LVAD in their end-stage

heart failure patients, more data on these pumps and their long-

term outcome will be available for clinicians in the future. This

pump has had CE approval in Europe since May 2009, and the

National Health Government solved the reimbursement issues

of these continuous-flow pumps in 2012.

Conclusion

Our study was not designed for the appropriate combination of

flow, power, pulsatily index and left ventricular unloading. It is

impossible to establish or document cause–effect relationships

while optimising LVAD parameters with so few patients. This

study was an observational analysis of a new-generation pump.

We believe that a concept should be studied in larger prospective

series with different pumps using serial echocardiographic

studies and comparing long-term outcomes of each pump.

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