10:02am Monday 25 September 2017

Artificial ventricle, alternative to heart transplants for patients with serious associated pathology

The operation was carried out successfully by the Heart Surgery Service at the University of Navarra Hospital last 27 September and, 18 days after the operation, the patient was released from hospital.

Ángel Luis Sánchez Bayón, a 66-year-old resident of Cadreita (Navarre), had a left ventricle with less than 15% capacity of ejection (blood pumping), added to which was a serious coronary pathology and diabetes as principal associated diseases. “Although the patient had a suitable profile as a candidate for a heart transplant, the, associated pathologies greatly complicated the viability of the operation”, stated doctor Gregorio Rábago, Director of the Heart Surgery Service at the University of Navarra Hospital and lead surgeon in the operation.

When referred to the Heart Surgery Service at the University of Navarra Hospital (Navarre Health Service), the team of heart surgeons at the hospital has to evaluate the most suitable option between a cardiac transplant or the implant of a permanent mechanical assistance device. After studying the medical record and the current situation of the patient, the specialists at both Navarre hospitals opted for this second option as the most beneficial therapeutic solution. Thus, Ángel Luis Sánchez Bayón from Madrid and resident in Cadreita (Navarre) became the second patient in the whole of Spain who had an artificial ventricle implanted permanently. The device is known as HeartMate II and also substitutes for an artificial heart. The operation was successfully carried out on 27 of September last. It lasted for 5 hours and the patient only needed 5 days in the ICU and 13 admitted to the ward for observation, before he was released.

The device

The Heartmate II artificial ventricle consists of a mechanical pump that functions in parallel with the heart, and connected at one end to the left ventricle and, at the other, to the aorta. Its principal function is to help the heat pump blood with the force required to get to all parts of the body, substituting for the action of the left ventricle. “The role of HeartMate is to provide the function of this ventricle”, stressed doctor Rábago.

The mechanical pump has a motor with a turbine that, on gyrating, pumps the blood. To this end, the turbine turns continuously thanks to a cable through which the energy necessary is received from two external batteries which the patient has to carry on a belt. Also, the device is in contact with a control system which, together with the batteries, forms part of an external circuit.

Advantages of the artificial ventricle

The batteries feeding the turbine of the artificial ventricle have a life of between 12 and 14 hours compared to the 5 of the artificial heart. According to the manufacturer, it is estimated that the useful life of HeartMate II is some ten years. Indeed, underlines doctor Rábago, “what is involved is a device which enables the patient to carry on quite a normal life, avoiding frequent or continuous hospitalisation”. From the moment of discharge from the hospital, this patient has been admitted only once in order to adjust his treatment and then is monitored in an out-patient manner by his cardiologist in Tudela and by the Heart Surgery Service at the University of Navarra Hospital.

Another advantage of HeartMate II is that “not involving a donor’s organ – as happens with heart transplants -, but an electronic device, rejection does not occur and so avoiding having to immunosupressor medication for the rest of one’s life”, stresses the specialist. The patient in question, Mr Ángel Luis Sánchez Bayón, showed very good tolerance to the artificial ventricle. The posterior control that the patient himself has to undertake involves taking the usual anticoagulant medication. We can be assured that, within one year, Mr Sánchez will have adapted totally to life with this device. The medication being taken before the operation has been significantly reduced and the constant hospital admissions avoided”, explained the heart surgeon.

At hospitals abroad the HeartMate II artificial ventricle is commonly used as a “bridging” solution while waiting for a heart transplant, “as in other countries these waiting lists are usually much longer than in Spain”, commented the specialist. In conclusion, doctor Rábago highlighted that “numerous international studies have demonstrated that the efficacy of these devices enables having a normal life for patients with terminal cardiac insufficiency  – to date without other  therapeutic options – and, moreover, involving considerable financial savings.”

Contact:
Jesús Zorrilla Ruiz
Clínica Universidad de Navarra
Contact details:
jzorrilla@unav.es
(+34) 948-296.497 / 948-255.400

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