A CASE OF THE «BERLIN HEART EXCOR» BIVENTRICULAR ASSIST DEVICE IMPLANTATION AS A BRIDGE TO HEART TRANSPLANTATION FOR A PATIENT WITH DILATED CARDIOMYOPATHY AND TERMINAL HEART FAILURE

Patients with terminal heart failure, refractory to drug therapy, are severe category of cardiology. The possibility of effective correction of multi-organ failure and an increase in the life-time of patients with critical cardiac insuffi ciency has been proved with the use of biventricular assist device (BiVAD). In this report, we present the case of implantation of the BiVAD «Berlin Heart EXCOR» as a bridge to orthotopic cardiac transplantation to a patient with dilated cardiomyopathy, critical heart failure and a high risk of fatal complications. Despite the complex, long postoperative period after the implantation of «Berlin Heart EXCOR», proceeded with reversible multiorgan and heart failure, dysfunction of BiVAD pumps, it was achieved patient’s recovery, regress of heart failure phenomena and orthotopic heart transplantation was performed after 9 months with a good long-term result.

terminal chronic heart failure, biventricular assist device, orthotopic heart transplantation

1. Merlo M, Cannatà A, Gobbo M, Stolfo D, Elliott PM, Sinagra G. Evolving concepts in dilated cardiomyopathy. Eur. J. Heart. Fail. 2018; 20 (2): 228–239. doi: 10.1002/ ejhf.1103.

2. McCartney SL, Patel C, Del Rio JM. Long-term outcomes and management of the heart transplant recipient. Best. Pract. Res. Clin. Anaesthesiol. 2017; 31 (2): 237– 248. doi: 10.1016/j.bpa.2017.06.003.

3. Lund LH, Trochu JN, Meyns B, Caliskan K, Shaw S, Schmitto JD et al. Screening for heart transplantation and left ventricular assist system: results from the Screening for advanced Heart Failure treatment (SEE-HF) study. Eur. J. Heart. Fail. 2018; 20 (1): 152–160. doi: 10.1002/ejhf.975.

4. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart. J. 2016; 37 (27): 2129–2200. doi: 10.1093/eurheartj/ehw128.

5. Trivedi JR, Cheng A, Ising M, Lenneman A, Birks E, Slaughter MS. Heart Transplant Survival Based on Recipient and Donor Risk Scoring: A UNOS Database Analysis. ASAIO Journal. 2016; 62 (3): 297–301.

6. Cologne, Germany: Institute for Quality and Effi ciency in Health Care (IQWiG). Systematic Guideline Search and Appraisal, as Well as Extraction of Relevant Recommendations, for a DMP «Chronic Heart Failure». Institute for Quality and Effi ciency in Health Care. 2015 Nov. Extract of Final Report No. V14–01.

7. Fu DM, Wang HQ, Zhang XL. Historical review of heart transplantation. Zhonghua Yi Shi Za Zhi. 2012; 42 (2): 89–99.

8. Liu Y, Maureira P, Gauchotte G, Falanga A, Marie V, Olivier A et al. Effect of chronic left ventricular unloading on myocardial remodeling: Multimodal assessment of two heterotopic heart transplantation techniques. J. Heart. Lung. Transplant. 2015; 34 (4): 594–603.

9. Dandel M, Krabatsch T, Falk V. Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation. Int. J. Cardiol. 2015; 198: 241–250.

10. Brehm K, Heilmann C, Siepe M, Benk C, Beyersdorf F, Schlensak C. Thoratec paracorporeal biventricular assist device therapy: the Freiburg experience. Eur. J. Cardiothorac. Surg. 2012; 41 (1): 207–212.

11. Levin AP, Jaramillo N, Garan AR, Takeda K, Takayama H, Yuzefpolskaya M et al. Outcomes of contemporary mechanical circulatory support device confi gurations in patients with severe biventricular failure. J. Thorac. Cardiovasc. Surg. 2016; 151 (2): 530–535.e2. doi: 10.1016/j. jtcvs.2015.10.019.

12. Lampert BC, Teuteberg JJ. Right ventricular failure after left ventricular assist devices. J. Heart. Lung. Transplant. 2015; 34 (9): 1123–1130. doi: 10.1016/j.healun.2015.06.015.

13. Bartfay SE, Dellgren G, Lidén H, Holmberg M, Gäbel J, Redfors B et al. Are biventricular assist devices underused as a bridge to heart transplantation in patients with a high risk of postimplant right ventricular failure? J. Thorac. Cardiovasc. Surg. 2017; 153 (2): 360–367.e1. doi: 10.1016/j.jtcvs.2016.09.084.

14. Philip J, Lopez-Colon D, Samraj RS, Kaliki G, Irwin MV, Pietra BA et al. End-organ recovery post-ventricular assist device can prognosticate survival. J. Crit. Care. 2018; 44: 57–62. doi: 10.1016/j.jcrc.2017.10.017.

15. Yoshioka D, Toda K, Yoshikawa Y, Sawa Y. Over 1200day support with dual Jarvik 2000 biventricular assist device. Interact. Cardiovasc. Thorac. Surg. 2014; 19 (6): 1083–1084. doi: 10.1093/icvts/ivu312.

16. Shehab S, Macdonald PS, Keogh AM, Kotlyar E, Jabbour A, Robson D et al. Long-term biventricular HeartWare ventricular assist device support – Case series of right atrial and right ventricular implantation outcomes. J. Heart. Lung. Transplant. 2016; 35(4): 466–73. doi: 10.1016.

17. Barnard CN. The operation. A human cardiac transplant: an interim report of a successful operation pe rformed at Groote Schuur Hospital, Cape Town. Circulation Pathology and Cardiac Surgery. 2017; 21 (3S): 101–106.