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Ann Thorac Surg 2007;83:282
© 2007 The Society of Thoracic Surgeons

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New Technology

Invited commentary

Cardiac Surgery and Transplant Unit, Papworth Hospital, Papworth Everard, Cambridgeshire CB38RE, United Kingdom

(Email: stephen.large{at}papworth.nhs.uk).

Mechanical assistance for the failing heart (LVAS) is needed, established, and evolving fast. The role of LVAS may be relatively brief (bridged to recovery, transplantation, or a further device) or protracted in life-long support. The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial [1] gave spirit to destination therapy (life-long support) by showing a threefold improvement in 2-year survival in New York Heart Association class 4 recipients of the bulky HeartMate I (Thoratec Corp, Pleasanton, CA) against best medical therapy. It also highlighted the shortcomings of support devices, including infection, thromboembolism, hemolysis, stroke, mechanical failure, and expense, to name the most prominent.

Gazzoli and colleagues [2] describe their first two clinical cases supported by a new, small, relatively simple to insert LVAS, the CorAide by Arrow (Reading, PA). This rotary device is compact and made of three components: an armature, a magnetically suspended impeller, and an outer housing. It is placed in the left ventricular apex and is able to deliver up to 5.5 L/min at 3500 rpm into the aorta through its 14-mm Hemashield (Boston Scientific, Natick, MA) outflow pipe. Extensive preparatory bovine work at the Cleveland Clinic during the last 10 years [3] has included support without anticoagulation and the development of a sister pump, the DexAide, for right ventricular failure.

This early Italian experience is promising with no reported complications as far out as 6 months after implantation. Previous work elsewhere in Europe (Bad Oeyenhausen) will no doubt join these two patients and others in a future report to give us a clearer picture of what appears to be a current attractive solution for the patient with severe refractory heart failure.

What is required is a pump that is small, easy to insert, fully implantable (to minimize infection), robust, resistant to thrombus formation and other complications, and very importantly, is cheap. Large numbers of heart failure patients could be helped by mechanical support. They are very likely to be denied this therapy through cost. The CorAide does not claim to meet all these demands, but it may represent a further small and cautious step in the right direction.

	References

Top References

 

1. Rose E, Gelijns A, Moskowitz, et al. Long-term mechanical assistance for end stage heart failure N Engl J Med 2001;345:1435-1443.[Abstract/Free Full Text]
2. Gazzoli F, Alloni A, Pagani F, et al. Arrow CorAide left ventricular assist system: initial experience of the Cardio-Thoracic Surgery Center in Pavia Ann Thorac Surg 2007;83:279-282.[Abstract/Free Full Text]
3. Doi K, Golding L, Massiello A, et al. Preclinical readiness testing of the Arrow International CorAide left ventricular assist system Ann Thorac Surg 2004;77:2103-2110.[Abstract/Free Full Text]

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