THE RESULTS OF MECHANICAL HEART SUPPORT SYSTEMS «INCOR» IMPLANTATION

Abstract

The aim of investigation isestimation of mechanical heart support system «INCOR» implantation efficacy. Materials and methods. The Institute of Circulation Pathology has clinical experience of mechanical circulatory support systems «INCOR» (Berlin Heart AG) implantation in 12 patients (10 men and 2 women) with severe heart failure during the period from November 2006 to October 2012. The main indication for the use of mechanical support of the left ventricle was a left ventricular failure with marked dilatation of the left heart: end-diastolic volume (EDV), LV – 283 ± 58 ml, end-systolic volume (ESV) – 233 ± 57 ml, ejection fraction (EF) – 16 ± 7%, with preserved function of the right ventricle (RV) (RV ejection fraction 35 ± 12%). Results. All patients showed a significant improvement in central hemodynamics in early postoperative period, reducing the volume of the heart chambers: LV EDV from 283 ± 58 to 183 ± 94 ml; LV ESV with 234 ± 57 to 157 ± 65 ml, increased right ventricular ejection fraction (RV EF ) (from 35 ± 12 to 43 ± 17%). Improve the function of the right ventricle oc- curred mainly due to the expense of left ventricular unloading and pulmonary circulation. In addition, there was a significant improvement in clinical status of patients – regression of symptoms of heart failure, a recovery of the liver and kidney function. Despite the ongoing anticoagulation and antiplatelet therapy under constant parameters of coagulation, there was some complications. Uterine bleeding occurred in 1 patient (16.6%), which required the abolition of anticoagulants and antiplatelet, uterine artery embolization, and as a result has led to thrombosis and stop system «INCOR». Four patients (33.3%) had severe thromboembolic complications – acute cerebrovascular accident (CVA). In 1 patient (8%) there was a hemorrhagic stroke due to rupture of intracerebral aneurysms with a breakthrough into the lateral ventricle of the brain. In 3 patients (25%) the late period (3–6 months after implan- tation) was accompanied by a purulent-septic complications, which required of antibiotic therapy administration. Time of INCOR functioning ranged from 17 to 948 days. Six patients (50%) underwent successful orthotopic car- diac transplantation at 180–948 days after left ventricle bypass system implantation. The remaining patients died from various complications: three patients from severe thromboembolic stroke, one patient died from hemorrha- gic stroke due to rupture of intracerebral aneurysms with a breakthrough into the lateral ventricle of the brain, one patient death was due to progressive right heart failure, another death occurred on background of chronic sepsis. Conclusion. Thus, implantable system for circulatory support «INCOR» using achieves significant regression of heart failure manifestations. But sadly, holding a mechanical heart support is associated with the risk of severe complications, such as thromboembolism, hemorrhagic stroke, sepsis and increase biventricular failure.

Keywords

• heart insufficiency, mechanical support system, left ventricle