Establishing a New Left Ventricular Assist Device Program: From Concept to Reality

Background: Left ventricular assist devices (LVAD) are a staple element in contemporary treatment of advanced heart failure. LVAD surgeries are mostly done in heart transplantations centers, as a destination therapy or as a bridge to heart transplantation. Objectives: To describe our step-by-step experience in establishing and implementing a new LVAD program in a nonheart transplant center. To give insight to our short- and long-term results of our first 25 LVAD patients. Methods: Preliminary steps included identifying the need for a new program and establishing the leading team. Next is defining protocols for preoperative evaluation, operating room, postoperative management, and outpatient follow-up. The leading team needs to educate other relevant units in the hospital that will be involved in the care of these patients. It is essential to work in collaboration with a heart transplant center from the very beginning. Patient selection is of major importance especially in the early experience. Initially low-risk patients should be enrolled. Results: We describe our first 25 LVAD patients. Our first five patients all survived beyond 2 years, with no major complications. Overall, there was one operative death due to massive GI bleeding. There were four late deaths due to septic events. Conclusions: Establishing a new LVAD program can be successful also with small- and medium-size programs. With careful and meticulous planning LVAD implantation can be extended to more centers thus offering an excellent solution for advanced heart failure patients.