Development of a hub-and-spoke durable left ventricular assist device program in Brazil, a middle-income country
Deborah de Sá Pereira Belfort,
Bruno Biselli,
Mônica Samuel Avila,
Renata Lopes Hames,
Stephanie Itala Rizk,
Fabrício Canova Calil,
Bruna Carneiro Oliveira,
Filomena Regina Barbosa Gomes Galas,
Ludhmila Abrahão Hajjar,
Nadine Oliveira Clausell,
Livia Adams Goldraich,
Ramez Anbar,
Edimar Alcides Bocchi,
Tadeu Thomé,
Roberto Kalil Filho,
Paulo Manuel Pêgo-Fernandes,
Fabio Biscegli Jatene,
Silvia Moreira Ayub-Ferreira
Affiliations
Deborah de Sá Pereira Belfort
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil; Corresponding author: Deborah de Sá Pereira Belfort, Alves Guimaraes 470, 05410-000 São Paulo, SP, Brazil.
Bruno Biselli
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Mônica Samuel Avila
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Renata Lopes Hames
Hospital Sirio-Libanes, São Paulo, SP, Brazil
Stephanie Itala Rizk
Hospital Sirio-Libanes, São Paulo, SP, Brazil
Fabrício Canova Calil
Hospital Sirio-Libanes, São Paulo, SP, Brazil
Bruna Carneiro Oliveira
Hospital Sirio-Libanes, São Paulo, SP, Brazil
Filomena Regina Barbosa Gomes Galas
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Ludhmila Abrahão Hajjar
Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Nadine Oliveira Clausell
Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
Livia Adams Goldraich
Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
Ramez Anbar
Hospital Sirio-Libanes, São Paulo, SP, Brazil
Edimar Alcides Bocchi
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Tadeu Thomé
Hospital Sirio-Libanes, São Paulo, SP, Brazil
Roberto Kalil Filho
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Paulo Manuel Pêgo-Fernandes
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Fabio Biscegli Jatene
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Silvia Moreira Ayub-Ferreira
Hospital Sirio-Libanes, São Paulo, SP, Brazil; Heart Institute (InCor), Instituto do Coração, Hospital das Clinicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
Background: In middle-income countries, costs limit widespred use of left ventricular assist device (LVAD) as a strategy for end-stage heart failure. We aim to describe the experience of a LVAD program in a middle-income country in a hub-and-spoke model. Methods: Patients fulfilling strict inclusion and exclusion criteria were referred from different centers in Brazil for LVAD implantation through a philanthropy program financed via a Brazilian Federal Government tax exemption structure. LVAD implantation was performed in a hub-and-spoke model with a single implanting center. Data were collected retrospectively using hospital records and telephone contact with other centers. Patients who received LVAD implants external to the philanthropic program, either at this or other Brazilian centers, were not included. Results: Between January 1, 2013 and December 31, 2020, 20 adult patients underwent long-term continuous flow LVAD implantation with decentralization of postimplant patient care in regional centers. Patients were referred from 11 centers from 7 states in Brazil and underwent LVAD implantation through a philanthropy program. The median age was 52.5 years and 85% were Interagency Registry for Mechanically Assisted Circulatory Support profile 3 patients. Two patients had Chagas cardiomyopathy. The overall survival censored for competing risks at 1 and 2 years were 90% and 84%, respectively. Three patients (15%) underwent heart transplantation in the first 2 years after LVAD implantation. Twelve patients returned to their original centers and were followed remotely. Conclusions: This study presents a successful LVAD implantation program in a hub-and-spoke model in Brazil. Centralization of LVAD implantation with decentralization of postimplant patient care in regional centers is feasible and safe, enabling optimal allocation of resources in middle-income countries.
